HIMSS CDS Guidebook Excerpts

The tasks, key lessons, worksheets, and key lessons below are part of the HIMSS CDS Guidebook titled, Improving Outcomes with Clinical Decision Support: An Implementer’s Guide. The information below will help guide you in configuring CDS interventions.

Tasks

Define the core components, parameters, and logistical details for each chosen intervention to optimize stakeholder acceptance, ease and cost of implementation, workflow effects, and benefits. Document these specifications (Worksheet 7-1).
Ensure that critical elements are present to permit the user to fully understand the information presented and to take appropriate action.
Run through likely intervention use cases to ensure that the intervention configurations will perform as intended.
Validate the proposed CDS interventions with appropriate stakeholders and obtain necessary approvals; maintain continuous and effective communication with stakeholders throughout the process to increase chances that the intervention design will deliver desired results (Worksheets 7-2 and 7-3).
Provide mechanisms to make sure that the interventions continue to work as expected in a complex and dynamic environment. This includes procedures to detect and handle changed circumstances, such as a modified code’s for a laboratory test or medication in a CDS or CIS database. (See Chapter 4 and 9 for more on maintaining interventions.) Consider backup and failsafe contingencies in case information system components that inform or deliver the intervention fail.

Key Lessons

There are many logistical details about an intervention that need to be carefully established to ensure that it leads to the desired benefit.
There are core structural parameters for each intervention type, including triggering, logic, supporting data, notification (including acknowledgement and escalation), presentation, and action items. You must optimize these to make your interventions easy to use, specific and helpful for the issue at hand, and effective in achieving objectives.
Workflow issues are again central in configuring interventions, as they were in selecting them. In particular, strive to improve user workflow (or at least avoid introducing significant new work), and to provide all the information and tools that users need to take action.
Make sure that CDS users and clinicians - not the computer - control care processes. The intervention should not introduce any new policies without prior stakeholder consensus, and likewise should not totally restrict any clinical behavior except when there are definite and severe patient risks.
Intervention configuration doesn’t end with launch. Robust plans for gathering and responding to feedback from those receiving or affected by the interventions are needed to keep the material relevant, accurate and valuable. Continue rich stakeholder dialog about the intervention details all the way through the intervention lifecycle – before, during, and after implementation until it is retired (see Chapter 4 and Chapter 9).

Worksheets

You can find the corresponding worksheets for this chapter here:

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