A description and functional taxonomy of rule-based decision support content at a large integrated delivery network.

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Decision support systems offer electronic medical record and clinical information systems (CIS) the greatest opportunity to improve the quality and lower the cost of healthcare. Unfortunately, efforts to classify and describe decision support systems suffers from a lack of generally agreed consensus on definitions, nomenclature, and models for structuring the evidence based and best-practice knowledge library.

Wright A, Goldberg H, Hongsermeier T, Middleton B. A description and functional taxonomy of rule-based decision support content at a large integrated delivery network. J Am Med Inform Assoc. 2007 Jul-Aug;14(4):489-96.


In the absence of a standardized system, developers have had to create proprietary and stand-alone taxonomies making it difficult to share decision frameworks with other institutions as well as maintain decision support libraries within organizations as it integrates with the clinical information system.


By reviewing the decision support system in place at Partners HealthCare, the authors purport to develop a taxonomy with limited and finite capabilities that would prove “Useful for developers of clinical information systems, decision support systems, and standards developers”.


Reviewing the Partners enterprise decision support knowledge management system, the investigators identified four categories that describe the functional components of the interface between the decision support system and the CIS (Table 1).

(Table 1) Taxonomy Functional Categories
Categories Descriptions
Triggers The events that cause a decision support rule to be invoked.
Input data The data elements used by a rule to make inferences.
Interventions The possible actions a decision support module can take.
Offered choices Many decision support events require users of a clinical system to make a choice.

The investigators determined that “Rule type” consisting of number of logically similar rules would serve as the base unit of analysis allowing them to limit the study to the smallest number of rule types while capturing upwards of 94% of the rules.


The study indicated that a robust decision support system capable of being used as a shared standard can be achieved with a relatively small set of functional components and across a finite set of categories. The authors outline several potential benefits and limitations of this taxonomy.


  • Development of knowledge representation standards and other broad standards development initiatives.
  • Development of certification standards for development of clinical information systems with integrated decision support


  • The taxonomy was developed from a single integrated decision support CIS delivery network. While the Partners network does offer a variety of institutions within its unified organization, it cannot account for all variations and unique cases of integration issues that may be encountered within other organizations.