P R O J E C T R E P O R T
WHAT I S A CDS : D I S PE L L I NG THE MYTHS AND DEF I N I NG THE PURPOS E
IAN CHUANG ELSEVIER HEALTH
a car. A GPS is a system of decision support, optimising and guiding the user to their end destination. I see this as a clear comparison to the purpose of a CDS. We can use a GPS passively, as a reference while we drive and self-navigate. It is informational, and as the driver you can choose whether to take advantage of the information presented. Furthermore, if a driver enters a destination, the GPS can suggest an optimal route, considering numerous factors, as well as user preferences. The choices are presented, with information regarding the trade-offs, before the driver ultimately decides themselves. Upon the driver’s decision, the GPS delivers a proposed route. In this scenario, a driver can still opt out and divert to another route. Crucially, the driver is always in control and is always making the final decisions. This augmented decision support operates much like a clinician uses CDS. Electronic medical records or other forms of information systems primarily support the process of care delivery from point A to B. For example, in the primary hospital care setting they support patient admission through to discharge. However, these systems provide no guidance on the optimum care to deliver. This is where a CDS comes into play, by offering the ability to guide these critical decisions. It is a clinician’s very own GPS, navigating the increasingly complex healthcare landscape.
Clinical decision support (CDS) has been on the radar of technologists, informaticians and clinicians since we started the process of digitalising health care in the 1970s. There has been much hype, as well as confusion regarding what a clinical decision support system can provide. For some clinicians, the experience has varied. However, it is important to take a step back and refocus on the true potential and value of CDS. When these CDS systems are based on good human-centred design, the utility can be extremely valuable for improving quality and safety
CDS misconceptions
The most common misconception about CDS is that computers will replace the role of a clinician and that decisions will become automated. This is not what CDS does, and nor should it. Computers do not control clinical decision-making through a CDS, instead, information is packaged and provided to complement clinical decision-making. Clinical decision support will never take a decision out of a clinician’s hands. A CDS is about augmentation, not automation.
CDS in action: order sets
A critical example of the power of CDS in action can be showcased through the clinical order set functionality. A clinical order set is a pre-defined template that provides support in making clinical decisions for a specific condition or medical procedure. It is a grouping of orders that standardises the process for a common clinical scenario. This concept of standardisation should never be confused with the clinician losing control or agency in
the purpose of CDS: the complexity of healthcare requires its own GPS
CDS augments clinical decision making, and it is important to explain how. I often draw similarities with a GPS in
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