title: Cross-vendor evaluation of key user-defined clinical decision support capabilities: a scenario-based assessment of certified electronic health records with guidelines for future development.
abstract: OBJECTIVE
  Clinical decision support (CDS) is essential for delivery of high-quality, cost-effective, and safe healthcare. The authors sought to evaluate the CDS capabilities across electronic health record (EHR) systems.
  
  
  METHODS
  We evaluated the CDS implementation capabilities of 8 Office of the National Coordinator for Health Information Technology Authorized Certification Body (ONC-ACB)-certified EHRs. Within each EHR, the authors attempted to implement 3 user-defined rules that utilized the various data and logic elements expected of typical EHRs and that represented clinically important evidenced-based care. The rules were: 1) if a patient has amiodarone on his or her active medication list and does not have a thyroid-stimulating hormone (TSH) result recorded in the last 12 months, suggest ordering a TSH; 2) if a patient has a hemoglobin A1c result >7% and does not have diabetes on his or her problem list, suggest adding diabetes to the problem list; and 3) if a patient has coronary artery disease on his or her problem list and does not have aspirin on the active medication list, suggest ordering aspirin.
  
  
  RESULTS
  Most evaluated EHRs lacked some CDS capabilities; 5 EHRs were able to implement all 3 rules, and the remaining 3 EHRs were unable to implement any of the rules. One of these did not allow users to customize CDS rules at all. The most frequently found shortcomings included the inability to use laboratory test results in rules, limit rules by time, use advanced Boolean logic, perform actions from the alert interface, and adequately test rules.
  
  
  CONCLUSIONS
  Significant improvements in the EHR certification and implementation procedures are necessary.
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA amccoy1@tulane.edu.
authors.forename: Allison B
authors.initials: AB
authors.lastname: McCoy
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA Partners HealthCare, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.affiliation: The University of Texas School of Biomedical Informatics at Houston, Houston, TX, USA.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
mesh_terms: D002568:Certification; D003132:Commerce; D020000:Decision Support Systems, Clinical / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D017408:Guidelines as Topic
keywords: clinical; decision support systems; electronic health records