title: A highly scalable, interoperable clinical decision support service.
abstract: OBJECTIVE
  To create a clinical decision support (CDS) system that is shareable across healthcare delivery systems and settings over large geographic regions.
  
  
  METHODS
  The enterprise clinical rules service (ECRS) realizes nine design principles through a series of enterprise java beans and leverages off-the-shelf rules management systems in order to provide consistent, maintainable, and scalable decision support in a variety of settings.
  
  
  RESULTS
  The ECRS is deployed at Partners HealthCare System (PHS) and is in use for a series of trials by members of the CDS consortium, including internally developed systems at PHS, the Regenstrief Institute, and vendor-based systems deployed at locations in Oregon and New Jersey. Performance measures indicate that the ECRS provides sub-second response time when measured apart from services required to retrieve data and assemble the continuity of care document used as input.
  
  
  CONCLUSIONS
  We consider related work, design decisions, comparisons with emerging national standards, and discuss uses and limitations of the ECRS.
  
  
  CONCLUSIONS
  ECRS design, implementation, and use in CDS consortium trials indicate that it provides the flexibility and modularity needed for broad use and performs adequately. Future work will investigate additional CDS patterns, alternative methods of data passing, and further optimizations in ECRS performance.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Goldberg
authors.forename: Marilyn D
authors.initials: MD
authors.lastname: Paterno
authors.forename: Beatriz H
authors.initials: BH
authors.lastname: Rocha
authors.forename: Molly
authors.initials: M
authors.lastname: Schaeffer
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Erickson
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D020000:Decision Support Systems, Clinical; D006751:Hospital Information Systems / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006801:Humans; D020407:Internet; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D012984:Software
keywords: clinical decision support; implementation; interoperability; service-oriented architecture; standards