Sources of clinical decision support content

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Clinical decision support (CDS) is populated and generated from a number of different sources. The information included in CDS systems may be generated from the medical record of a specific patient or from a databank of medical knowledge, but all of the tools in CDS systems have the same aim – to enhance patient care.

Perhaps the most relevant source of information within CDS is the patient record. This patient-related information may include the patient’s current and previous medications, problem list, lab results, results from radiographic and imaging studies, and other data. This data is derived directly from the electronic health record and may alert to potential drug interactions, risk factors, or follow up tests. While patient-specific data may be the most relevant to treating one individual, it can only be truly valuable if all of the patient data is available to the physician at the time a decision must be made.


Other CDS knowledge content comes from one of four types of systems:

Standalone system

these operate separately from EMR systems and require that all patient information is entered manually.

Integrated system

these systems can be built into an EMR eliminating the need to manually enter patient information, but may hinder cross-site sharing of information.

Standards-based systems

provides information based on rules and is presented in a standardized format so that information can be shared between systems.

Service architectures

EMR and CDS systems are separate but allows interface between the two for patient data and recommendations.

External sources of CDS content come from published clinical knowledge. “Clinical knowledge” is defined as the best available evidence on a topic. This may include safety guidelines, dosing recommendations, diagnosis assistance, or treatment plans. Knowledge bases for CDS may be an embedded piece of an EMR or a web-based service that responds to patient information transmitted over HTTP.

Introduction to Service-Oriented Architecture in Healthcare

Often called Service-Oriented Architecture (SOA), these types of CDS knowledge bases are designed to meet the needs of specific business units and fully encapsulated within EMR software platforms. One problem with EMR-embedded CDS knowledge sources is that they exist as plug-ins rather than fully integrated. These knowledge bases may be domain-specific and added for their relevance to a specific department. Software must be maintained by the manufacturer and updated periodically in order to remain viable. The upside of using these knowledge bases is that it is available within the EMR and provides immediate feedback or information when queried.

Web-based knowledge bases provide a network of information across domains and specialties. Although this knowledge is stored remotely, an EMR may be set to access a number of support services based on patient-specific inputs. Advantages with this type of knowledge are range of domains, lack of downtime due to updating, use between institutions, and open authorship. It is advisable that organizations opting to pursue this CDS knowledge route ensure that the selected data band is compliant with HL7 standards.

Related Study

Key principles for a national clinical decision support knowledge sharing framework synthesis of insights from leading subject matter experts


  2. Kawamoto K, Lobach DF. Design, implementation, use, and preliminary evaluation of SEBASTIAN, a standards-based web service for clinical decision support. AMIA Annu Symp Proc. 2005; 2005: 380-38
  3. Kawamoto K, Lobach DF. Proposal for fulfilling strategic objectives of the U.S. roadmap for national action on decision support through a service-oriented architecture leveraging HL7 services. J Am Med Inform Assoc. Mar-Apr 2007; 14(2): 146-15
  4. Wright A, Sittig DF. SANDS: An architecture for clinical decision support in a national health information network. AMIA Annu Symp Proc. 2007; 2007: 816-820.

Submitted by Erin Watson