Table 4
Incentives and Protections to Support CDS Adoption
| Incentive | Suggested Actions | Possible Government Roles | Time Frame |
| Legal protection | Consider protecting prescribers' decisions to accept/reject CDS interventions from discovery; removes fear of liability from rejecting intervention (and hence, fear of having interventions) | Convene discussion over pros and cons of various proposals | ASAP |
| Alternative proposals recommend encouraging protection by documenting the reason for overriding CDS recommendations | Enact legislation or rule making to provide appropriate protection so as to remove fear of adoption of CDS | ||
| Appropriate protection for authors/publishers of CDS knowledge | |||
| Malpractice relief or reduction for CDS use | Use of CDS systems should lead to malpractice relief secondary to expectation of reduced adverse events | Support research demonstrating impact of CDS on outcomes (and malpractice outcomes) | Research support ASAP |
| CDS use should become standard of care | Convene malpractice insurers to consider options | ||
| CDS-related incentives and funding | Incentive tiers: funding and incentives should insist on basic level performance and should be greater for systems that include a minimum number of advanced level performance elements (per Table 2) | Tiering is a structural recommendation, to be considered by CCHIT | 2006 |
| Revise Stark and antikickback safe harbors to allow more funding options for eRx systems with CDS | DHHS and Congress to work to enact expanded Stark and antikickback safe harbors | ||
| CDS certification basis | Possibilities for certification criteria: | Acknowledge and coordinate work of various organizations, e.g., Leapfrog Group and ISMP, in developing test sets and criteria | Ongoing |
| Based on existence of features as shown in Table 2 (verifiable) | Encourage CCHIT to define progression and to monitor when to move to higher levels | ||
| Based on performance against standard test sets of data | |||
| Based on provider's use of system, activation of features and regular use | |||
| Based on reporting of actual occurrence of CDS events and supporting information | |||
| Higher levels are successively more robust but also more difficult to implement. Recommendation: start at level 1, steady movement to higher levels, as technical possibilities permit |
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CDS = clinical decision support; ASAP = as soon as possible; eRx = electronic prescribing; CCHIT = Certification Commission for Healthcare Information Technology; DHHS = Department of Health and Human Services; ISMP = Institute for Safe Medication Practices.
