Practice Management

Overcoming Hurdles in Clinical Decision Support

Learn how to successfully implement clinical decision support tools in your practice

Physician typing on keyboard

Clinical decision support (CDS) encompasses a variety of tools (See list below) that can be delivered on various platforms, ranging from smartphones to cloud-based software programs. If not implemented properly, CDS can become an aggravating stumbling block for many clinicians. Robert Greenes, MD, PhD, professor of biomedical informatics at Arizona State University and the Mayo Clinic in Arizona, offers tips on successfully implementing CDS in physician practices.


“A lot of the concerns I see on usability are bad design and bad user interface,” Greenes says. EHR/CDS vendors are not necessarily the culprits, he explains—they just aren’t able to adapt to every practice’s needs. Having a good working relationship with the EHR or CDS vendor is crucial, and, in some instances, it may be a good investment to hire experts for help with customization, he adds.

Accurate Alerts

Crafting an alert or CDS tool to be as accurate as possible is another key to success. If there are too many obstacles to triggering the alert under the right context, “providers will either turn it off, if they have that option, or ignore it,” Greenes says. When providers turn these alerts off, the quality of patient care can decrease. To set up relevant alerts, clinicians can focus on the “Five Rights” (See list below).

Up-to-Date CDS Tools

“Another challenge is keeping [CDS] up-to-date,” Greenes explains. “Rules change, and order sets may change.” Although larger health care systems have dedicated staff to do this, smaller practices should consider appointing an interested staff member to keep the system updated or consult their EHR/CDS vendor for assistance.

Types of CDS

  • Reminders and alerts
  • Clinical guidelines/reference information
  • Condition-specific order sets
  • Patient data reports
  • Documentation templates
  • Diagnostic support

“Five Rights” for CDS Implementation

  1. The right information (e.g., guidelines, expert consensus)
  2. Delivered to the right people (appropriate care team members)
  3. Via the right channel (e.g., EHR, mobile devices, patient portals)
  4. In the right format (e.g., order sets, dashboards, flow sheets)
  5. At the right point in workflow (to streamline decision making/action)


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