The quality and safety of medical care in the United States have drawn increased attention in the past decade. Studies suggest many errors could be avoided with the use of health information and communications technology (HIT).i
Such improvements have been facilitated by the adoption of computerized provider order entry systems, electronic medical records that improve accessibility to clinical data, and a variety of approaches loosely grouped together and referred to as clinical decision support (CDS) systems. To foster better health processes, better individual patient care, and better population health, CDS systems intelligently provide, at appropriate times, knowledge or information (person-specific or population-specific). Clinicians, patients and individuals thus benefit from CDS.5
Clinical decision support interventions may include alerting and reminder systems, dosing calculators, and order sets and tools that provide access to medical knowledge at the point of care. Evidence suggests that computerization of medical record systems and even implementation of provider order entry systems may not be sufficient to ensure high quality care.6
Rather, CDS represents the effecter arm for clinical process improvement,2–4
provided that it is effectively utilized and implemented with careful consideration of clinical workflow.
In the summer of 2005, the Office of the National Coordinator for Health Information Technology (ONC), along with the Agency for Healthcare Research and Quality (AHRQ) asked the American Medical Informatics Association (AMIA) to develop a plan to guide federal and private sector activities to advance CDS. In response, AMIA established the CDS roadmap development steering committee to lead this effort. A set of meetings and consensus panels led to the production of the roadmap for national action on CDS (the ‘CDS roadmap’) in 2006.5
This report recommended activities to facilitate CDS development, implementation and use throughout the United States to improve the quality, safety and efficiency of healthcare. The roadmap included a critical path that recommended activities in the three-year timeframe following the report's publication.
Since then, significant effort by numerous stakeholders, including federal agencies, quality organizations, informatics groups, healthcare systems and individual researchers have devoted effort to CDS. To assess national progress in CDS, we conducted an environmental scan, reviewing published literature, white papers, reports by multiple stakeholders and recent legislation. Using the critical path activities as a framework, our report presents a synthesis of progress to date. We discuss future directions and recommend specific next steps, taking into consideration trends in clinical computing and increased availability of funds to support HIT as part of the recent US federal stimulus package.