ASHP Guidelines on the Design of Database-Driven Clinical Decision Support: Strategic Directions for Drug Database and Electronic Health Records Vendors

Abstract

ASHP believes that use of clinical decision support (CDS) tools can make patient care more efficient and effective.1 Currently available pharmacotherapy CDS systems are not as effective as they need to be at helping all practice settings achieve the goal of safe and effective pharmacotherapy. The focus of these guidelines is commercially available pharmacotherapy warning systems such as drug interaction, allergy, and dose monitoring CDS. Pharmacotherapy warning CDS systems are collectively referred to as “database-driven CDS” in these guidelines. Database-driven alert associations are compiled by drug database vendors and are incorporated as alerts into clinical information systems by electronic health record (EHR) vendors. All practice settings are usually limited in their ability to customize the content of messages or severity levels of alerts created by the drug database or EHR vendors. In contrast, free-form, rule-based alerts are created by users based on coded logic rules using information contained in the EHR database. Although free-form, rule-based alerts are an important tool, these guidelines limit their focus to active, interruptive database warnings. These guidelines outline an approach that would provide all practice settings with the power and flexibility to implement database-driven CDS so that it is a useful tool for improving the quality, cost efficiency, and safety of medication use. Adoption of this functionality by all practice settings is of course critical to meeting the goal of delivering improved, patient-centered care. These database-driven CDS rules should be shareable between all practice settings so that each institution can make the customizations needed for its particular circumstances.