ORLANDO—When it comes to clinical decision support (CDS), it’s time to “think outside the alert box,” according to a presentation at the Health Information and Management Systems Society's annual conference.

“It takes a lot more to improve outcomes than popping up an alert in front of somebody’s face,” said Jerome A. Osheroff, MD, of the University of Pennsylvania in Philadelphia. “In fact, a lot of the challenges that we face in clinical decision support now result from the fact that this is how we’ve done clinical decision support in the past.”

Osheroff said CDS is more of a process, and providers should focus on the “five rights” of CDS: The right information, to the right people, in the right formats, through the right channels at the right time.

Expanding on the idea that CDS is not just about alerts, Jonathan Teich, MD, PhD, from the department of emergency medicine at Brigham & Women’s Hospital, Boston, and CMIO for Elsevier, said “CDS is not about giving you alerts, CDS is about giving you the information you need to make the best decision right now.”

Teich said that since it’s so easy to make an alert, there is a tendency to put too many of them in place or to include non-specific alerts. Physicians then get tired of them and may just start ignoring an overabundance of alerts.

CDS does have its benefits—Teich cited a study from his organization that found implementing CDS with the order entry system immediately cut dosing errors by 75 percent—and that there are opportunities for CDS across the workflow.

For example, in addition to immediate alerts or ordering sets, CDS could also function as an ED tracking system that color codes patients based on severity or time in the ED.

In all, Teich outlined 10 types of CDS interventions:

1. Immediate alerts, warnings and critiques

2. Event-driven alerts and reminders

3. Order sets, care plans and protocols

4. Parameter guidance

5. Smart documentation forms

6. Relevant data summaries for a single-patient

7. Multi-patient monitors and dashboards

8. Predictive and retrospective analytics

9. Filtered reference information and knowledge resources

10. Expert workup advisors

“What I really want from decision support is the best next step,” said Teich. “I want something that’s fast, something that’s useable, something that’s pertinent to my situation.”