Say the phrase “clinical decision support” in the middle of a crowded doctor’s lounge and watch what happens. Half the doctors will ignore you, some of them will take this opportunity to walk out because they have something better to do (like scheduling that root canal they’ve been putting off for two years), a few of them will actually get mad because the practice of medicine "just isn’t what it used to be", and maybe one or two will engage in a debate about its usefulness.

But what exactly is CDS?

Now if your eyes just glazed over while your brain quickly flitted to safer ground like ‘what are they serving for lunch in the cafeteria?’ read on because this article is for you.

Many doctors still think of CDS as the computer telling them how to practice medicine. I’ll admit, I used to mumble under my breath when the EHR would prompt me to “consider a cesarean delivery for this patient” – “REALLY? And what medical school did this computer go to? I’m the doctor! I’ll decide if this patient needs a cesarean or not!”

The government has mandated that physicians must not only adopt and implement an Electronic Health Record (EHR), but they must also prove that they are using it in a meaningful way. One of the measures required to achieve Meaningful Use is implementing Clinical Decision Support. Stage 1 of Meaningful Use requires one CDS rule to be implemented and tracked for compliance and Stage 2 requires five rules. The goal of this mandate is certainly admirable – to reduce medical errors and improve patient outcomes – and no good doctor would argue with that. However, the fear of many doctors is that these guidelines, protocols and rules that are built into the EHR will force them to accept and practice “cookbook” medicine, removing the art of the profession.

Combining patient information with Clinical Decision Support provides real-time data that is actionable towards improving patient outcomes. It is presenting the right information at the right time to the right person to lead to the best outcome. Consider an example for a patient with hypothyroidism. The rule written into your EHR states that a TSH will be checked every 12 months in patients with a diagnosis of hypothyroidism who are taking levothyroxine. When you see a patient who has these particular characteristics, an alert will fire at just the right time to suggest adding a TSH to the orders.

We already use Decision Support

I would suggest that we are already using similar systems in other areas of our lives, such as when we drive a car. There are many systems built into modern cars to improve safety. My car has a Lane Departure Warning system which is a mechanism designed to warn a driver when the vehicle begins to move out of its lane (unless a turn signal is on in that direction.) I would suggest that this is the same as a CDS alert in the EHR.

Of course you can choose to ignore, dismiss or override the alerts. Maybe you know your patient had the lab drawn at another provider’s office last month. Or maybe you are well aware that you are changing lanes without signaling because it is 2:00 a.m. and there is not another car in sight.

The rules and protocols that make up Clinical Decision Support may actually make it easier for us to practice the art of medicine because our minds will be freed from the mundane details and we can concentrate on critically thinking about what’s really going on with the patient. CDS is just one more tool we can use to help us achieve the ultimate goal of improved patient care.

How do you feel about Clinical Decision Support?