Friday, October 30, 2015

What are Clinical Decision Support and Infobuttons?

Hi readers! I was very excited when I was recently asked to give a brief overview of Clinical Decision Support (CDS)! What is it, exactly? Since I enjoy sharing front-line #Informatics insights in this blog, for educational purposes,  I thought I would share some of the slides from my presentation : 

Clinical Decision Support (CDS) is a term that is commonly used in health technology circles. What it means, however, is somewhat more elusive, because it doesn't just represent one tool - It's a whole toolkit of tools, used to steer clinical people in the right direction at the right time

The take-home message of these slides is that CDS is :
  • A very powerful and broad toolkit of tools that helps answer questions and guide people towards the right decisions at the right times.
  • Not just pop-up alerts! E.g. CPOE or BPA (Best Practice Alerts)!
CDS comes with the noble goal of the "Five Rights" of CDS

... which, in practice, take significant work and thought to achieve all five goals. Some concerns people have voiced about CDS include : 

And just for educational purposes, I included these two very simple forms of decision support which people can easily relate to, both seen below : 

(You may recognize the actor Wilford Brimley above, who very effectively educates patients about the potential importance of medical therapies, allowing patients to then speak to their providers about potential therapies.)

In any case, I'm so thankful that the very talented Informatics leader Dr. Guilherme Del Fiol, MD PHD has already spent years researching and studying CDS, and in 2014 published this great study in JAMA about what happens with questions that arise, among physicians, during real clinical care :

What Dr. Del Fiol identified in this landmark paper is that almost half of patient interactions result in a question about clinical care - Either about drug treatment, symptoms, tests, or physical findings - And when these questions do arise, only about half of them get answered, often because of a clinical lack of time to research an answer, or doubt that a useful answer exists!

The implications of this research is that almost 60% of these information needs are not being met! Fortunately, there is enormous potential for infobuttons to connect providers to instant, context-sensitive education. A great, short video demonstrating the power of infobuttons can be found here : 

... and fortunately there is a large project underway to standardize and develop infobuttons, which can be found at In any case, Dr. Del Fiol and others have shown the real potential for infobuttons to reduce search times for information, and increase the accuracy of answers : 

... and through this strategy, the VA has seen a remarkable impact on the delivery of care : 

... which is why I believe Infobuttons will continue to grow and evolve as a clinical decision support tool. It not only provides clinicians with fast, real-time, context-sensitive information, but it has the potential to change the entire educational model for physicians : 

So my take-home messages about CDS and Infobuttons? 

And anyone wishing to pursue additional references : 

I hope this was a helpful introduction to the concepts and tools of Clinical Decision Support, and the role that Infobuttons play in that toolkit. Special thank you to Dr. Guilherme Del Fiol (and many other talented #Informatics leaders) for their work in publishing these very important studies, which help us understand opportunities to help improve the efficiency and accuracy of care delivery.

What are your thoughts about CDS? Do you have any favorite CDS tools? Feel free to leave comments section below!