Developing and implementing clinical decision support for use in a computerized prescriber-order-entry system

Abstract

The development and implementation of clinical decision support (CDS) in a computerized prescriber-order-entry (CPOE) system in a large, tertiary care, academic health care system are described. CDS is generally considered to be a key factor in promoting successful system adoption, patient safety, and positive patient outcomes for CPOE implementation. The impact of CDS depends on the methods used by the institution to implement CPOE using both passive and active system design features. At the University of Michigan Health System, interdisciplinary project teams were assembled to plan, build, and implement the CDS component of CPOE using several underlying fundamental principles to ensure the usability and safety of the system, including standardization of system configuration, workflow design, and prioritization of the number and types of interruptive alerts that would be deployed. Passive CDS rules were established for nomenclature, links to information, relevant results, and order sets. Active CDS rules were developed for noninterruptive alerts (patient list alert flags and form-called medical logic modules) and interruptive alerts, including alerts for allergies, dose checks, drug-drug interactions, drug-food interactions, and drug-disease interactions. The institution provided sufficient staffing and institutional governance to implement and sustain CDS. Through an interdisciplinary collaboration, an academic health care system planned, designed, and implemented institution-specific, CPOE-integrated CDS to improve clinical efficiency and facilitate the compliance with regulatory policies and guidelines.