A Brief History of Clinical Decision Support: Technical, Social, Cultural, Economic, and Governmental Perspectives

This chapter discusses a wide variety of technical approaches that have been explored for developing clinical decision support (CDS) over almost a half century. Some of the approaches have been focused on generating and representing knowledge, others on how to deliver and use it. The chapter considered the many factors that have contributed to a current sense of urgency for robust, high-quality CDS. The first of those factors is a technology imperative, born of the rich history of research and development that has made CDS possible, and in a sense inevitable-it is possible, so it will be done. The remaining factors that have become particularly compelling in the most recent few years constitute a "sociocultural imperative"-it is needed, so it will be done. The necessary factors have been identified required to implement robust, widespread CDS to foster health care safety, quality, and efficacy, recognizing the slow progress to date. Understanding of the features allows the effective design of both CDS capabilities and health care IT environments, so that the two can be harmoniously integrated. At the same time, given the need for separate maintenance and update of CDS, this understanding will help to identify the needed infrastructure to support its life cycle processes effectively.