title: Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems.
abstract: BACKGROUND
  Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems.
  
  
  OBJECTIVE
  To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs.
  
  
  METHODS
  We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4).
  
  
  RESULTS
  Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common.
  
  
  CONCLUSIONS
  We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA. awright5@partners.org
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Joshua
authors.initials: J
authors.lastname: Feblowitz
authors.forename: Seth
authors.initials: S
authors.lastname: Meltzer
authors.forename: Carmit
authors.initials: C
authors.lastname: McMullen
authors.forename: Ken
authors.initials: K
authors.lastname: Guappone
authors.forename: Jim
authors.initials: J
authors.lastname: Carpenter
authors.forename: Joshua
authors.initials: J
authors.lastname: Richardson
authors.forename: Linas
authors.initials: L
authors.lastname: Simonaitis
authors.forename: R Scott
authors.initials: RS
authors.lastname: Evans
authors.forename: W Paul
authors.initials: WP
authors.lastname: Nichol
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D003132:Commerce; D020000:Decision Support Systems, Clinical / Q000145:classification*; D003697:Delphi Technique; D057286:Electronic Health Records; D019538:Health Care Surveys; D006801:Humans; D012985:Software Design; D013673:Technology Assessment, Biomedical; D014481:United States