The Evolution of Clinical Decision Support

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Clinical Decision Support and the Evolution to Shared Decision Making (SDM)

While clinical decision support systems (CDSSs) focus on the clinician’s needs and connect to electronic health records (EHRs); health information technology (HIT) tools are broadening in scope. The same clinical decision support systems designed to assist healthcare professionals with decision tasks are evolving to assist patients with making decisions. The shift from clinician to consumer and family focused clinical decision support systems is a notable trend that has surfaced in recent years. The overarching goals of improved patient safety, quality of care, and patient outcomes serve as the driver for CDSSs and consumers may contribute to these goals by serving an active role in their healthcare. Research also suggests that informed and engaged consumers lead to better patient outcomes. (1)

Introduction to Clinical Decision Support


Shared Decision Making (SDM) and Decision Aids

Shared decision making involves not only medical evidence and the clinician’s expertise; it also incorporates the patient’s knowledge, values, and personal preferences. This information is shared, exchanged, and prioritized making both the clinician and the patient active and accountable parties in treatment discussions resulting in joint treatment decisions. Decision support systems for consumers are defined as decision aids which assist patients to make informed choices when deciding between various options to manage their or their families care. (1,2)

Types of Decision Aids (2)

• Paper-based Forms

• Health Education Videos

• Computer-based Applications

Internet-based Consumer Decision Support Systems (1)

As the development of consumer decision support systems progresses internet-based and on-line consumer sites have also begun to emerge and they include:

• Comprehensive Health Enhancement Support (CHESS)

• Database of Individual Patient Experiences (DIPEx)

• Foundation for Informed Medical Decision Making (FIMDM)

Mayo Clinic




PatientSite (Beth Israel Deaconess Medical Center)

PAMFOnline (Palo Alto Medical Foundation)

Benefits of Shared Decision Making (2)

• Increased knowledge management options

• Likely improved patient outcomes

• Greater in-home patient self-management

• Less uncertainty

Health Information Technology and Consumer Decision Support

While decision aids are useful when patients are faced with complex medical decisions, they have the potential to be more efficient when integrated into an electronic health record (EHR) or personal health record (PHR). Fiks discusses the results of a systematic review conducted by Kohn, Corrigan & Donaldson (2000), where the patients’ key needs to effectively participate in health decisions were identified. The source, timing, delivery, and content of information needs was preferred compared to information alone, this research illustrates the need for further development of consumer DSSs. (2) Furthermore, the use of the existing PHR infrastructure may accelerate the development and integration of consumer DSSs. (1)

Integrated consumer decision support systems may utilize the following HIT tools: (2)

• Personal Health Records

• On-line Self Management

• Patient Portals

• Email

• Social Media

• Office-based Kiosks

Furthermore, tools must be matched to the patient in order to be effective; in addition, usability is an important consideration when introducing a consumer DSS. Personalized tools may mitigate the known challenges of consumer use of health information technology. These issues include: confidentiality, privacy, and usability.

Benefits of Integration (2)

• Increased communication between the patient and provider

• Clinician may be alerted of necessary treatment, follow-up needs, potential problems, and treatment plan deviations

• May contribute to forecasting adherence to treatment plan

• Help capture and track the progress of patient goals

• Engages both the clinician and patient

Future Research Areas

• Consumer Usage of HIT

• Usability

• Human Factors

In order to maximize the benefits of clinical decision support systems, expanding the context to consumers is necessary and within reach. New approaches which build upon and integrate existing clinician-focused CDSSs and patient-focused decision aids will advance the decision making process with the potential to improve patient outcomes, medical decision making, and health communication. (2)


(1) Coiera E, Lau AY, Tsafnat G, Sintchenko V, Magrabi F. The changing nature of clinical decision support systems: a focus on consumers, genomics, public health and decision safety. Yearb med inform 2009:84-95.

(2) Fiks AG. Designing computerized decision support that works for clinicians and families. Current Problems in Pediatric & Adolescent Health Care 2011 Mar;41(3):60-88.

Submitted by: C. B.