Decision Support Service

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The HL7 Decision Support Service (DSS) specification provides a standard API (application programming interface) for service-oriented clinical decision support (CDS). The DSS version 1 specification became an HL7 normative standard in 2011. The standard provides a common interface for EHRs and other clinical information systems (CIS) to utilize CDS functionality external to the CIS [1].

How It Works

A CIS wishing to utilize decision support services needs to be able to package patient data into a standard format, invoke the remote service using standard SoA methods, and process the output produced by the service. The CIS displays results of the remote CDS activity using its usual methods for displaying information, alerts, or reminders [2].

Currently the DSS standard does not mandate how the patient data input to the service needs to be structured. However, two HL7 standards for structuring data have been used with DSS: the Virtual Medical Record(vMR)[1] (To learn more about Virtual Health Records visit [1] (VLER) and the Continuity of Care Document (CCD).

DSS requires standard terminologies to be used for encoding data. For example: RxNorm for medications, SNOMED for problems/diagnoses, and LOINC for laboratory results.

It is important to note that the DSS standard does not indicate how the CDS is actually implemented. For example, it could be an MLM written in Arden, a rule in an rules engine such as JBoss Drools, or any number of other programming or implementation methods.

Related Projects


OpenCDS is the reference implementation of the DSS and vMR standards. It utilizes all open-source components to support a framework for service-oriented CDS.

CDS Consortium Enterprise Clinical Rules Service

The CDS Consortium's Enterprise Clinical Rules Service (ECRS) is another service-oriented CDS project which uses the DSS standard for its interfaces. This allows CDS rules and guidelines developed in the Consortium to be exposed to organizations interested in participating in their projects [3].

Health eDecisions (HeD)

Health eDecisions is an initiative chartered by the ONC's Standards and Interoperability Framework. Health eDecisions has two goals: first to identify a common format and mechanism for sharing of CDS knowledge artifacts and rules, and second, to identify standard(s) for decision support services. DSS is the standard currently being supported by this second goal and the next version will incorporate changes from HeD trials. The deliverable of the HeD initiative will be an implementation guide for CDS guidance services [4].


  2. Jenders RA, Del Fiol G, Kawamoto K. The Practice of Clinical Decision Support: Applying Standards and Technology to Deliver Knowledge-Driven Interventions. AMIA Annu Symp Proc. 2012 Nov 3;2012.
  3. Paterno MD, Goldberg HS, Simonaitis L, Dixon BE, Wright A, Rocha BH, et al. Using a Service Oriented Architecture Approach to Clinical Decision Support: Performance Results from Two CDS Consortium Demonstrations. AMIA Annu Symp Proc. 2012 Nov 3;2012:690–8.

Submitted by Kevin Heard.