Features of Computer-Based Clinical Decision Support

The purpose of this chapter is to dig deeper into the nature of computer-based clinical decision support, in terms of the ways in which it is or potentially could be used, its design, and its interaction with host environments. It points out that much of the success with CDS has been with one-off implementations that have been difficult to maintain over time even within their own institutions, more problematic when extended for use throughout a health care enterprise, and only rarely replicated elsewhere despite demonstrated effectiveness. It addresses those areas that need to be better understood in order to improve the situation. An underlying thesis is that CDS has a conceptual architecture comprised of a number of design elements or components. A second thesis is that CDS does not function in isolation, but rather that it operates in the context of some sort of application environment. These two concepts are helpful to better understand how to design CDS in a portable, reusable, maintainable fashion.