Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan
Report of the Joint Clinical Decision Support Workgroup
- Jonathan M Teich,
- Jerome A Osheroff,
- Eric A Pifer,
- Dean F Sittig,
- Robert A JendersThe CDS Expert Review Panel
- Affiliations of the authors: Healthvision, Waltham, MA (JMT); Department of Emergency Medicine, Brigham and Women's Hospital and Harvard University, Boston, MA (JMT); Thomson Micromedex, Denver, CO (JAO); Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA (JAO, EAP); Northwest Permanente, PC, Portland, OR (DFS); Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Sciences University, Portland, OR (DFS); Department of Medicine, Cedars-Sinai Medical Center, University of California, Los Angeles, CA (RAJ)
- Correspondence and reprints: Jonathan M. Teich, MD, PhD, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail: <jteich{at}harvard.edu>
- Received 8 March 2005
- Accepted 23 March 2005
Abstract
Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption.
Footnotes
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Supported by the Agency for Healthcare Research and Quality through a program of health information white papers to be produced by AMIA. Additional logistical and staff support was provided by HIMSS as a project of the Patient Safety and Quality of Care Steering Committee. See the Appendix (available as an online data supplement at http://www.jamia.org). for a full discussion of the role and project focus of each participating organization.
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The authors thank the entire CDS Expert Review Panel for their helpful input and gratefully acknowledge the additional support and personal contributions of Gail Arnett, Doug Bell, Jeff Blair, Dasha Cohen, Kelly Cronin, Mike Fitzmaurice, Karen Greenwood, Zeba Kimmel, Nancy Teich, and Pat Wise.
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Approved by the AMIA Board of Directors as an official white paper on March 14, 2005.
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↵* The terms EMR and EHR are in a state of evolution. In this paper, we use the most current common usage available, specifically, an EHR is a collection of all person-centric health information; an EMR is a specific application primarily used in ambulatory care for clinical documentation, orders, data review, and workflow.
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↵† Bruce Bagley, Marion Ball, David Bates, Douglas Bell, Jeff Blair, Jennifer Covich Bordenick, Suzie Burke-Beebe, Kelly Cronin, Don Detmer, Carol Diamond, Robert Elson, Michael Fitzmaurice, Mark Frisse, Tejal Gandhi, Peter Geerlofs, Lynne Gilbertson, Patricia Hale, Kathy Hollinger, Zebadiah Kimmel, Robert Kolodner, Gil Kuperman, Mark Leavitt, Michael Lake, Stuart Levine, Jane Metzger, Blackford Middleton, Arnold Milstein, Stuart Nelson, Eduardo Ortiz, Marc Overhage, Stan Pestotnik, Helga Rippen, Karen Trudel, Emily Welebob. Full affiliations of the panel members are available online as a data supplement at http://www.jamia.org.
