Clinical Decision Support System (CDSS)
Any system designed to improve clinical decision-making related to diagnostic or therapeutic processes of care. Typically a decision support system responds to "triggers" or "flags"—specific diagnoses, laboratory results, medication choices, or complex combinations of such parameters—and provides information or recommendations directly relevant to a specific patient encounter.
CDSSs address activities ranging from the selection of drugs (e.g., the optimal antibiotic choice given specific microbiologic data) or diagnostic tests to detailed support for optimal drug dosing and support for resolving diagnostic dilemmas. Structured antibiotic order forms represent a common example of paper-based CDSSs. Although such systems are still commonly encountered, many people equate CDSSs with computerized systems in which software algorithms generate patient-specific recommendations by matching characteristics, such as age, renal function, or allergy history, with rules in a computerized knowledge base.
The distinction between decision support and simple reminders can be unclear, but usually reminder systems are included as decision support if they involve patient-specific information. For instance, a generic reminder (e.g., "Did you obtain an allergy history?") would not be considered decision support, but a warning (e.g., "This patient is allergic to codeine.") that appears at the time of entering an order for codeine would be. A recent systematic review estimated the pooled effects for simple computer reminders and more complex decision support provided at the point of care (i.e., as clinicians entered orders in computerized provider order entry systems or performed clinical documentation in electronic medical records).