Delivery of CDS Recommendations to Users
Key questions in designing or selecting CDS systems are whose decisions are being
supported, what information is presented, when it is presented, and how it is presented to the
user. Although it is usually assumed that the physician is the clinician whose decisions are being
supported, in some cases it has been found that CDS is more effective if nurses and other clinicians receive the information. As for timing, the most effective time to present some kinds
of information may be immediately at the point of care—for example, delivering an alert about
drug-drug interactions during the prescribing process. Other information, such as the names of
patients being seen on a given day who need immunizations, may be less disruptive when
delivered prior to the patient encounter. The information from the CDS can be presented
automatically to the clinician or “on demand” (i.e., when the clinician chooses to access the
information). Whatever the features of CDS delivery of information, the quality of the
information and the evidence underlying it are the major determinants of the impact of CDS on
patient safety and quality improvement. The description by Osheroff, et al. of what they call the
“five rights” of CDS is a good summary of what is needed for effective delivery: CDS should be
designed to provide the right information to the right person in the right format through the right
channel at the right time (i.e., when the information is needed).