Clinical Decision Support: A tool of the Hospital Trade

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This is a review of the Article "Clinical Decision Support: A tool of the Hospital Trade". [1] by Eric G. Poon.


There’s gradual progress being made in Electronic Health Record (EHR) adoption as seen in most hospitals in the United States, Such progress is increasing by the year. In 2014, 6 out of 10 hospitals have a functional EMR [1], such tool guides and enables clinicians make informed decisions. EMR as a form of Clinical Decision Support (CDS) improves quality of care received, curtails the rate of Adverse Events (AE) and ensures efficiency of both clinical and hospital resources during patient care. Although there are benefits in the use of EMR as a form of clinical support, such potential also presents itself with limitations.


One of the benefits in utilizing CDS systems was through the use of targeted electronic prompts in a clinical setting for acid suppressive therapy. Such utility proved beneficial in preventing ordering of acid suppressive therapy outside of an Intensive Care Unit (ICU) Setting.

Investigators also were also able to establish a reduction in ordering behavior with time and a gradual trend in prescribers willing to utilize alternate medications for stress ulcer prophylaxis as opposed to acid suppressive therapy.


The reduction in ordering behavior was observed as clinicians and prescribers frequently circumvent recommendations offered by a CDS system.

Clinicians may be hesitant to follow recommendations provided by decision support due to poor design, poor implementation, lax deployment strategies and reluctance to challenge performance goals of CDS systems.

Other studies have identified potential shortcomings of CDS as was stated in this article by Beeler et al., (2014) Clinical decision support systems.

Summary and Conclusion

The science of CDS is in the maturation phase, its evolution and influence largely depends on the approach clinicians and prescribers take in reconciling both the limitations and benefits and addressing factors such as organizational trust, clinician input and organizational support for CDS systems.


My assumption on why physicians would deliberately circumvent recommendations offered by decision support stems from clinicians attitude on the recommendations it offers. Clinicians trust their experience which stems from medical training, years of practice and exposure in treating various clinical conditions in their field of expertise while being apprehensive in utilizing recommendations offered by a decision support that was designed with a poor algorithm.


  1. 1.0 1.1 "Poon, E. G. (2015). Clinical Decision Support: A Tool of the Hospital Trade. Journal of Hospital Medicine, 10(1), 60-61.