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The 2012 HIMSS Guidebook on Improving Outcomes with CDS defines clinical decision support as follows:
"a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery."
Information recipients can include patients, clinicians and others involved in patient care delivery; information delivered can include general clinical knowledge and guidance, intelligently processed patient data, or a mixture of both; and information delivery formats can be drawn from a rich palette of options that includes data and order entry facilitators, filtered data displays, reference information, alerts and others.
The CDS 5 Rights framework asserts that, to improve targeted healthcare decisions/outcomes with well developed & deployed CDS interventions, the interventions must provide:
the right information,
to the right people,
in the right intervention formats,
through the right channels,
at the right points in workflow
The CDS 5 Rights concept and approach was first articulated by Jerome Osheroff, MD in 2006 and shared in with stakeholders in various presentations and other venues. The approach was described formally in the 2009 book "Improving medication use and outcome with CDS: a step-by-step guide." This framework and its application are further detailed in the 2012 book "Improving outcomes with CDS: an implementer's guide, second edition."
Understanding and leveraging effectively these 'what, who, how, where, when' information flow dimensions is central to configuring useful CDS/care transformation/quality improvement (QI) approaches. The CDS guidebooks mentioned above devote considerable attention to how to set up CDS programs - and how to configure, vet, test, launch and evaluate CDS interventions - to get these 'CDS 5 Rights' right. The CDS/PI Collaborative (active in the 2010s and covered on this archive website) brought together interdependent stakeholders to 'get better faster - togetherSM' at improving outcomes by applying the CDS 5 Rights approach via structured CDS/QI worksheets to document, analyze, share and improve target-focused approaches transform care.
CMS recommends the CDS 5 Rights framework as a best practice approach to health IT-enabled quality improvement. A 2023 webinar by Osheroff describes collaborative efforts over the past several years to accelerate care transformation toward the quintuple aim through scalable approaches to getting the CDS 5 Rights right for many care delivery and public health improvement imperatives.
Getting the CDS 5 Rights right requires fully leveraging available options in each of the 5 component dimensions. The CDS/QI Worksheets (and the Health Service Blueprints they have evolved into) contain suggestions to help you broadly consider these options. The 2012 CDS guidebook provides further details on options in these 5 CDS configuration dimensions. Relevant excerpts from the CDS guidebook, along with other helpful information about the CDS 5 Rights dimensions and other implementation guidance, are available in CDS/QI Resources.
EHR/HIT vendors often provide the 'format' and 'channel' dimensions for CDS interventions so their attention to optimizing their capabilities - in collaboration with their provider clients - can be particularly important in advancing target-focused CDS efforts.
Broadening the Framework: The LHS 5 Rights for Learning Health Systems1:
The CDS 5 Rights framework (which focuses primarily on clinical decisions) can be expanded to address the broader learning health system cycle, whereby evidence is synthesized into guidance that is put into action to support health and clinical decisions and actions, which generates data, that is synthesized into evidence. Ideally this produces a continually improving cycle that drives progress toward the quintuple aim.
Echoing and broadening the CDS 5 Rights framework, the LHS 5 Rights framework is an approach to supporting decisions and actions better to optimize processes and outcomes throughout the LHS cycle by getting:
the right information and tools/resources
to the right people
in the right formats
though the right channels
at the right times
(1first articulated by JAO, September 2019 as the "Decision/Action Support 5 Rights" framework; renamed September 2021 as the "LHS 5 Rights" framework)
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