Clinical Decision Support (CDS)

Clinical Decision Support Systems (CDSS) are applications that assist clinicians in the provision of care by providing prompts through the analysis of clinical data. These applications require patient specific clinical variables and as a result of running these variables against the decision support rules, they can provide patient specific recommendations. CDS encompasses, but is not limited to providing computerized alerts, recommendations and best practices at the point of care. The use of Clinical Decision Support (CDS) capabilities within Electronic Health Record (EHR) holds great promise for the public health. For example, decision support tools integrated with an EHR system can provide clinicians with recommendations on high priority clinical preventive services and benchmark clinical outcome for comparative analysis. Public Health Decision Support is a discipline that leverages the use of CDSS to advance population/public health goals. The integration of decision support into EHR systems offers significant potential to improve the population health outcomes and enhance quality-of-care. For example, alerts and reminders already have been implemented in EHR systems for the purposes of improving adherence to guidelines to improve screening for the immunization of high-risk persons for influenza , identifying high-risk persons for tuberculosis screening , and alerting physicians of potential prescribing errors.

The mission of CDC’s Division of Informatics Practice, Policy and Coordination (DIPPC) is to improve the practice and translation of Public Health Informatics through outreach and coordination. This mission supports CDC programs by supporting public health with informatics strategy, management, and technical expertise.

The mission of the DIPPC Decision Support Program is to help CDC’s public health programs achieve their goals by successfully leveraging Clinical Decision Support (CDS) frameworks, tools and best practices. The goal is to offer a suite of services which aid programs in developing and executing effective CDS strategies as part of their guidance, dissemination, and data gathering activities. The activities described below facilitate the information exchange between public health and the clinical community to assist providers with better patient and population management information and services.

The Decision Support Team is engaged in the following activities:

• Establishing the DIPPC Clinical Decision Support Community of Practice (CDS CoP) to support individual programs in improving their CDS effectiveness faster by sharing successful CDS approaches and best practices within CDC and with external organizations. The goals of the CDS CoP include:
  • Identifying intersections between clinical decision support, clinical preventive services, and population health
  • Providing a platform for CDC programs to share their experiences and develop collaborative strategies
  • Developing collaborations between public health programs and provider entities to promote better public health outcome
  • Adoption of informatics best practices and standards to facilitate interoperability and evaluating their impact on public health outcome
• CDS CoP
• Piloting a proof of concept that seeks to provide actionable information to the medical providers at the point of care through an Electronic Medical Record (EMR) system. The goal of this project is to enable two-way communication among the various providers in the healthcare community and public health using EMR alerts. CDC is demonstrating how public health can leverage this new opportunity to bring public health information and disease management guidelines at the point of care.
• Understanding and translating the role of CDS in Meaningful Use formulations by participating in national policy and standard setting activities.
• Participating on the expert panel for the Immunization Clinical Decision Support Project. The Immunization Information Systems Support Branch (IISSB) within the National Center for Immunization and Respiratory Diseases (NCIRD) has initiated an Immunization Clinical Decision Support Project which is funded by American Recovery and Reinvestment Act (ARRA). This specification will be developed by the expert panel through a consensus-based process to ensure the broadest IIS application.
• Developing a Geospatial Community Health Record (CHR). Community Health Decision Support seeks to ensure that community stakeholders including the public, local government, clinical care, community organizations, education sector and businesses have access to reliable, relevant, and timely information at the local level in order to advance community and population health programs, investments, and decision making. The CHR is an interactive Geographic Information System (GIS)-based application that enables linking and easy visualization of aggregate electronic health record data with public health and socioeconomic and environmental databases. It provides local information to community stakeholders in a manner that promotes knowledge, facilitates communication, informs decisions, policies and encourages accountability