How-To Guides for Clinical Decision Support (CDS) Implementation
The guides below are intended for both clinical and technical staff who are defining CDS clinical goals; planning and leading CDS implementations; and maintaining and monitoring CDS interventions. To this end, Clinical Directors, Directors of Information Systems, Chief Medical Information Officers, and Directors of Medical Informatics, as well as other health care organization leaders, would benefit from reviewing the guides and associated resources.
The Guides are presented as five separate documents covering five major stages or phases in implementing CDS.
Guide 1- Start with a Strong Foundation for CDS [PDF - 202 KB]: Provides steps and resources to help organizations decide whether or not to use CDS as part of a quality improvement initiative.
Guide 2- Assemble a CDS Implementation Team [PDF - 158 KB]: Helps organizations understand the roles necessary to implement CDS and to begin planning for acquiring or developing and implementing CDS interventions.
Guide 3- Plan for Successful CDS Development, Design, and Deployment [PDF - 191 KB]: Helps match CDS interventions to the work processes and goals of the organization.
Guide 4- Roll Out Effective CDS Interventions [PDF - 147 KB]: Offers recommendations for roll-out planning and for training. These activities help to ensure a smooth transition between planning and roll-out, or going live.
Guide 5-Measure Effects and Refine CDS Interventions [PDF - 173 KB]: Provides steps to ensure that the effects of interventions are appropriately measured and monitored. This includes measures reported to external agencies and feedback about usability from individual clinicians.
Key Lessons in Clinical Decision Support (CDS) Implementation
This technical report distills key lessons in CDS implementation based on a comprehensive literature review, interviews with CDS Implementers, and lessons identified by exemplary practices. Lessons are organized by implementation stages and by practice type and size such as small outpatient practices and large academic hospitals. Interesting, practical examples and engaging quotes highlight real-life lessons and success factors drawing from several types of CDS. This resource is designed to help new CDS implementers such as providers complying with Meaningful Use requirements learn from the experiences of CDC implementers in order to be more successful in their implementation.
Download: Key Lessons In Clinical Decision Support Implementation [PDF - 2 MB]
References and Resources for Best Practices in Clinical Decision Support Implementation and Design
This deliverable provides resources to support the design, implementation, and use of Clinical Decision Support. The parenthetical numbers next to some of the tools and worksheets correspond to the matching numbers contained in the zip file. Other tools and resources are hyperlinked to a website where they are freely available.
There are three main categories of tools:
Tools and Figures: These resources provide information in the form of tables, figures, or online tools. Examples include tables describing stakeholder roles, online tools and questionnaires to help assess readiness, or figures that describe the different types of CDS Interventions.
HIMSS Worksheets: These worksheets are adapted from the HIMSS CDS book Improving Outcomes with Clinical Decision Support: An Implementer’s Guide, Second Edition. These worksheets will be partially filled out as an example of how to use them, but are provided as word documents so that modifications may be made as necessary.
Literature: Key studies including literature reviews are provided throughout this document. In each case annotation is provided to describe the content and use of a particular study. Hyperlinks are available for each source.
* Persons using assistive technology may not be able to fully access information in this file. For assistance, contact ONC at firstname.lastname@example.org.
- CDS Intervention Typology [PDF - 118 KB]
- Tasks for CDS Implementation [PDF - 149 KB]
- Organizations to Support Use of Health IT [PDF - 529 KB]
- Working with Outside Experts [PDF - 39 KB]*
- Decision Support Evaluation Tools [PDF - 160 KB]*
- Workflow Taxonomy [PDF - 96 KB]*
- Workflow User Guide [PDF - 217 KB]*
- Workflow Process Mapping Tool [PDF - 102 KB]*
- Questions to Consider about Organizational Knowledge Management [PDF - 58 KB]*
- Small Practice Considerations [PDF - 249 KB]
- Stakeholder, Goals, Objectives [PDF - 139 KB]
- Checklist for CDS Goal Charter [PDF - 106 KB]*
- Stakeholder Responsibilities and Role Descriptions [PDF - 122 KB]*
- Roles and Responsibilities of Clinical and Non-Clinical Stakeholders [PDF - 114 KB]*
- Setting Up an Alert [PDF - 96 KB]
- Creating An Alert Based On Quality Measures And Clinical Guidelines [PDF-71 KB]
- Objective Classes and Workflow Opportunities [PDF - 98 KB]
- Clinical Information System (CIS) Inventory [PDF - 170 KB]
- CDS Knowledge Asset Inventory [PDF - 135 KB]
- Linking Systems and Objectives [PDF - 132 KB]
- Selecting Interventions and Workflow Opportunities [PDF - 98 KB]
- Prelaunch Testing [PDF - 117 KB]
- Metric Selection and Use [PDF - 129 KB]
- Intervention Specification Form [PDF - 103 KB]
- Specification Validation and Approval Form [PDF - 90 KB]
- “From-To” Example [PDF - 70 KB]
- Intervention Launch Plan [PDF - 82 KB]
- Implementation Status [PDF - 102 KB]
- 8x8 Communication Example [PDF - 61 KB]
- Skeletal Outline of Different Stakeholders and Their Potential Evaluation Role [PDF - 72 KB]
- Key Attributes to Track for Deployed CDS Interventions [PDF - 81 KB]
- Use and Usability Issues Log [PDF - 104 KB]
- Performance against Objectives [PDF - 87 KB]
- CDS Program Enhancement Plans [PDF - 96 KB]
- Decision Log [PDF - 112 KB]
- Feedback and Resolution [PDF - 99 KB]
Clinical Decision Support Starter Kit
The Clinical Decision Support Starter Kit [PDF - 192 KB] is designed to help small practices take the first steps toward implementing CDS tools. This Starter Kit will help implementers become familiar with CDS, and it provides step-by-step examples of how to manage the implementation of a CDS rule. Users of the CDS Starter Kit will gain an understanding of:
- CDS and the rationale for using it
- Five types of commonly used CDS
- The relationship between CDS and Meaningful Use goals
- Examples of how to implement CDS rules that relate to Meaningful Use
This Starter Kit is designed for practices that have completed an EHR implementation and are now ready to implement CDS tools.
Downloads: Starter Kit [PDF - 192 KB] | Condition Example - Diabetes [PDF - 1 MB] | Condition Example - Smoking Cessation [PDF - 435 KB]
Strength in Numbers — Shared Resources for Implementing Clinical Decision Support in the Small Practice
This resource is designed to help small practices leverage shared resources nationally, regionally, and locally to overcome their inherent resource limitations to successfully implement and use CDS in their practices.
Download: Shared Resources for Implementing Clinical Decision Support in the Small Practice [PDF - 129 KB]
Profiles of Exemplary Sites
The ACDS project sought out practices which were recognized for their implementation of CDS. Many of the practices within the compendium were winners of the HIMSS Davies Awards. The compendium of exemplary practices contains two related deliverables:
- An excel spreadsheet providing contact information for the practices and an overview of the key lessons and type of decision support used.
- For each of the practices recognized, there is a profile summary that provides greater depth about the organization, the IT environment, CDS achievements, and lessons learned.
(All organizations recognized in the compendium were given the opportunity to review and correct the information provided in the profiles. These corrections were incorporated into the deliverable.)
- Adventist Health System [PDF - 88 KB]
- Brigham and Women's Hospital [PDF - 75 KB]
- Cardiology Consultants of Philadelphia [PDF - 134 KB]
- Center for Behavioral Health/Centerstone [PDF - 130 KB]
- Cincinnati Children's Hospital Medical Center [PDF - 92 KB]
- Citizens Memorial Healthcare [PDF - 97 KB]
- Cooper Pediatrics [PDF - 92 KB]
- Department of Veterans Affairs [PDF - 103 KB]
- Eastern Maine Medical Center [PDF - 68 KB]
- El Camino Hospital [PDF - 78 KB]
- Evans Medical Group [PDF - 90 KB]
- Geisinger Health System [PDF - 119 KB]
- Generations+ / Northern Manhattan Health Network [PDF - 102 KB]
- Memorial Hermann Healthcare System [PDF - 67 KB]
- MultiCare Health System [PDF - 95 KB]
- NewYork-Presbyterian Hospital [PDF - 107 KB]
- Pediatrics at the Basin [PDF - 144 KB]
- Physicians at Sugar Creek [PDF - 63 KB]
- Providence Portland Medical Center [PDF - 82 KB]
- Queens Health Network [PDF - 73 KB]
- Reid Hospital & Health Care Services [PDF - 70 KB]
- The Children's Hospital of Philadelphia (CHOP) [PDF - 63 KB]
- University of Illinois (UIH) Hospital [PDF - 74 KB]
- VA Puget Sound Health Care System (VAPSHCS) [PDF - 53 KB]
- Valdez Family Clinic [PDF - 78 KB]
- Vanderbilt University Medical Center [PDF - 127 KB]
- Village Health Partners (Family Medical Specialists of Texas) [PDF - 148 KB]
- Wishard Health Services [PDF - 99 KB]
Reference Workflow Taxonomy
The Reference Taxonomy of Clinical Workflows provides a common set of terms to CDS designers and implementers to support communication about CDS and its use in clinical workflows.
- CDS designers can use the taxonomy to identify points in the workflow when CDS can be used and design a CDS tool to fit that context. Designers can then tag the CDS tools with terms from the taxonomy to inform practices about the intended use of the CDS.
- CDS repositories can create tags based on the taxonomy to enable workflow-related organization and searches.
- CDS implementers can refer to the taxonomy when developing maps of the workflows and can use the terms to improve communication with their CDS vendor.