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

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.

Introduction

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:

• 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.

Methods

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.