Features of Computer-Based Clinical Decision Support

This chapter discusses the nature of computer-based clinical decision support (CDS), in terms of the ways in which it is used, its design, and its interaction with host environments. Understanding these aspects of CDS is important as a foundation for serious efforts to increase its dissemination and adoption. Much of the success with CDS is with on-off implementations that are 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. To tackle this issue and break down barriers to dissemination and adoption, the most troublesome aspects need to be identified for improvement, and which components or interfaces can be standardized or made easier to deploy. An understanding of the human factors, process, and workflow implications of CDS use is essential to determine optimal approaches to invocation and user interface design. The design principles are discussed to create CDS in a portable, reusable, and maintainable fashion. The two conceptual idealizations include-an underlying component architecture for CDS, and modularity of CDS in that its tasks and responsibilities can be separated from those of the application environment with which it interacts.