Exploring a clinically friendly web-based approach to clinical decision support linked to the electronic health record: design philosophy, prototype implementation, and framework for assessment

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This is a review of Miller, Phipps, Chatterjee, Rajeevan, Levin, Frawley, and Tokuno’s 2014 article, Exploring a Clinically Friendly Web-Based Approach to Clinical Decision Support Linked to the Electronic Health Record: Design Philosophy, Prototype Implementation, and Framework for Assessment.[1]


Clinical Decision Support (CDS) is a health IT component which aids clinicians in the decision making process during a patient visit. The goal of CDS is to provide overall better care for patients through the use of specific tools: [2]

  • Computerized alerts and reminders to care providers and patients
  • Clinical guidelines
  • Condition-specific order sets
  • Focused patient data reports and summaries
  • Documentation templates
  • Diagnostic support and contextually relevant reference information

The authors in this article are testing whether CDS can be implemented into EHRs in a clinician friendly manner. The team worked on the VA’s national EHR and implemented a specific prototype involving Neuropath/CDS. Previous studies have shown the importance of CDS during clinical decision-making.


The authors of the article chose to look at Neuropathic Pain and implemented a web based CDS to aid the final decision making of a clinician. While a clinician is on the clinical interface, he/she is able to select the CDS from the Computerized Patient Record System (CPRS). If this option is chosen, the server then retrieves the patient’s information to be used with the web interface. The key aspect is the Neuropath/CDS knowledge base (KB). This knowledge base is the main point from where the recommendations will flow based on checking and unchecking of specific conditions. Extensive testing was conducted with staff and clinicians to review comments and recommendations for improvements.


The primary focus of the study was to fine-tune the clinical interface between PCP’s and Neurology department when treating Neuropathy Pain. As a result, all clinicians were satisfied with the system and the recommendations they were able to receive without having to consult a neurologist.

The scope was then centered on first-line pharmacologic agents. A major issue discussed was making a clinical decision on a patient who was to receive a second or third-line drug. In this case, further adjustments needed to be made to the system.

In terms of the content of the study, clinicians were very satisfied in being able to receive necessary drugs to administer and correct doses in a timely manner.

The area where the most feedback was received was in the presentation. Clinicians had numerous suggestions on how the EHR interface with the CDS tool could be modified for appearance.


CDS systems when integrated in EHRs are believed to have a number of benefits: Avoid or reduce medication errors and adverse events; increase quality of care and enhance better health outcomes; improve efficiency and cost-effectiveness; and improve provider and patient satisfaction. The Decision-making tools are key to achieving these benefits.[2]

The implementation of the Neuropath/CDS is just the beginning of what can be done within EHRs. A continuing goal will be to include other types of pain management control for various conditions.

Conclusions viewed within the article show that the implemented prototype indeed aided PCP’s while making clinical decisions. The overall goal is to have clinicians use the CDS tool in order to make quicker and better decisions instead of being a burden.


This is a great pilot project to determine what steps need to be taken in order to improve CDS within EHR interfaces. The way the authors set up the methods was great in order to get a thorough and honest feedback from practicing clinicians. The results from the project will be beneficial moving forward in trying to implement this software in other medical areas. Isabel is another web based CDSS that facilitates diagnostic reminders and differential diagnoses.


  1. Miller, Phipps, Chatterjee, Rajeevan, Levin, Frawley, and Tokuno. Exploring a Clinically Friendly Web-Based Approach to Clinical Decision Support Linked to the Electronic Health Record: Design Philosophy, Prototype Implementation, and Framework for Assessment. doi: 10.2196/medinform.3586. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC4288105/
  2. 2.0 2.1 http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds