Clinical Decision Support: Strategies for Success

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This is a review of Mohamed Khalifa's 2014 article, “Clinical Decision Support: Strategies for Success”. [1]


The author explains the importance of evidence based medicine in quality of care in any healthcare setting and the role of CDS in improving this effort. He explains the benefits of CDS for physicians, caregivers and patients by helping them in decision making which enhances patient care. Author categorizes areas that CDS can be applied into 8 categories:

  1. Computerized alerts and reminders
  2. Clinical guidelines [1]
  3. Clinical pathways
  4. Order sets
  5. Patient data reports and dashboards
  6. Documentation templates
  7. Diagnostic support
  8. Clinical workflow tools.

Finally, author identified three levels of CDS functions:

  1. Clinical information management tools that automates data entry and information retrieval
  2. Tools that emphasize on the users (E.g. possible drug interactions validators)
  3. More specific patient advices based on patient specific data

Design and Implementation Challenges and Barriers

Author initially emphasized on the importance of a well-described success factors for CDS design. Additionally, he mentioned the weaknesses of physicians in utilizing computer systems which he believes remained unattended by CDS vendors. Besides, he states the risk of losing physician’s independence from computerized system with the use of CDS. However, CDS are able to present the best evidence-based practice automatically, without requiring extra thought or work and therefore, be able to focus on areas which needs more attention and as a result, improve patient safety as well as physician’s safety.

Success Strategies and Requirements

The author proposes 10 strategies in order to achieve success in the process of CDS development:

  1. Including the right content which comes from the clinical guidelines and protocols of the hospital
  2. Providing valid and reliable information to avoid inaccurate or irrelevant alerts, with false positive messages, which might lead eventually to a persistent condition of users’ alert fatigue as a consequence of the high sensitivity but low specificity of these alerts.
  3. Delivering simple messages to understand and respond and decrease effort and time required by physicians to read, understand and respond to the system advice and can be acquired by providing clear recommendations on how to respond to the message.
  4. Providing users with scientific references to build more trust in the validity, reliability and credibility of the whole system.
  5. Saving users’ time by providing links and associations between different fields of data.
  6. Integrating CDS into clinical workflow to avoid users breaking their workflow routines for data entry or data retrieval and disturb or break the clinical workflow.
  7. Improving system response and speed by providing system recommendations to the users in a timely manner and at the correct point in the decision making process.
  8. Adopting active alert mechanisms where users are informed about doing the right things automatically, instead of waiting for them to make mistakes and inform them about invalid decisions.
  9. Integrating CDS with EMRs instead of providing standalone CDS that require special efforts and redundant entry of patient specific data.
  10. Managing CDS knowledge with a continuous ongoing effort to guarantee the long term success of the system to keep it up to date and error-free and it needs an established mechanism of updating clinical rules and related guidelines and pathways.


The author concluded his article by stating the challenges of maintaining knowledge content with a large amount of data. As he states in his paper, clinical knowledge changes so quickly that it needs dedicated resources to keep an eye on the ever growing number of guidelines, protocols and algorithms with new clinical evidence appearing every day.


This paper is a succinct but comprehensive summary in clinical decision support system challenges with some hand-on and practical elaborations which help readers understand the logic behind each issue and also understand why a success factor matter. I believe the factors provided in this article are extremely vital for any CDS development project and can be considered as cornerstone of any success factor definition plan.


  1. M. Khalifa. Clinical Decision Support: Strategies for Success. Clinical Decision Support: Strategies for Success.