J Am Med Inform Assoc 14:141-145 doi:10.1197/jamia.M2334
  • Perspectives on Informatics
  • White paper

A Roadmap for National Action on Clinical Decision Support

  1. Jerome A Osheroffa,b,
  2. Jonathan M Teichc,d,
  3. Blackford Middletone,
  4. Elaine B Steenf,
  5. Adam Wrightg,
  6. Don E Detmerh
  1. aThomson Healthcare, Denver, CO
  2. bUniversity of Pennsylvania Health System, Philadelphia, PA
  3. cElsevier Health Sciences, Philadelphia, PA
  4. dDepartment of Medicine (Emergency Medicine) Harvard University, Boston, MA
  5. eClinical Informatics R&D, Partners Healthcare System, and Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
  6. fEditorial and Research Consultant, American Medical Informatics Association, Portland, OR
  7. gDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
  8. hPresident and CEO, American Medical Informatics Association, Bethesda, MD, Professor of Medical Education, Department of Public Health Sciences, University of Virginia, Charlottesville, VA
  1. Correspondence and reprints: Dr. Don E. Detmer, American Medical Informatics Association, 4915 St. Elmo Avenue, Suite 401, Bethesda, MD 20814; (e-mail: <detmer{at}>).
  • Received 21 November 2006
  • Accepted 12 December 2006


This document comprises an AMIA Board of Directors approved White Paper that presents a roadmap for national action on clinical decision support. It is published in JAMIA for archival and dissemination purposes. The full text of this material has been previously published on the AMIA Web site ( AMIA is the copyright holder.


  • Funding supporting AMIA’s work on this document obtained through HHS ONC Contract HHSP233200500877P.

  • The authors acknowledge the contributions of many individuals who helped to shape and provided input on this Roadmap. Richard Singerman served as project liaison for the Office of the National Coordinator for Health Information Technology (ONC). He was involved in, and provided valuable input to, each step of planning and execution of this initiative.

  • Karen Greenwood and Dasha Cohen from AMIA organized the October 2005 workshop devoted to creating this Roadmap. Judy Ozbolt coordinated meeting site logistics with the Institute of Medicine. Remarks by Carolyn Clancy and David Brailer during the workshop help to shape the workshop deliberations. Many of the workshop participants provided comments on a draft workshop summary as well as two drafts of this Roadmap. In addition, other individuals provided comments during the Roadmap review process. All of these individuals are listed in Appendix 2-E.

  • The American College of Medical Informatics (ACMI) members devoted their January 2006 meeting to review and discussion of the ideas contained in this Roadmap and in so doing helped to inform and validate the recommended approach. Eta Berner led the program committee that organized this meeting.

  • Karen Bell provided thoughtful guidance on how the Roadmap could relate to other ONC initiatives. Eric Pifer helped to personalize the vision of CDS in the scenario that appears in Section II of Appendix 2. Tia Abner from AMIA assisted with the production of this document.

  • ONC’s sponsorship, and the initiation of the current project, arose in part from another consensus white paper project, also sponsored by ONC and the Agency for Healthcare Research and Quality (AHRQ) and executed jointly by AMIA and the Healthcare Information and Management Systems Society (HIMSS). This initial white paper identified necessary enablers for realizing the potential of CDS in electronic prescribing (Teich et al., 2005).

  • A summary of this workshop is available at A graphic illustrator captured the content of the workshop presentations and discussions in a visual format. These images are also available at

  • Adapted from Improving Outcomes with Clinical Decision Support: An Implementer’s Guide, HIMSS, Osheroff et al., 2005. See online Appendix 2, Appendix B for snapshots illustrating sample CDS interventions.

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