Achieving the five rights for CDS presents challenges, and the challenges differ depending
on how closely the CDS is tied to what the clinician already intends to do. Clinicians may
initially want certain reminders or, after performance assessments, agree that they need other reminders, but in either situation they are choosing to receive the reminders. The key issue in reminding the user about things they choose to be reminded about is the timing of the reminder.
For instance, should reminders for preventive care be given to the physician in advance of the
patient visit (e.g., the day before), or should the reminders appear during the patient’s visit?
Key issues for consultation that the user seeks out (on-demand CDS) are speed and ease of
access. Users may recognize the need for information, but may be willing to access it only if
they can do so efficiently. If access is too difficult or time-consuming, potential users may
choose not to use the CDS.
The major issue involved in correcting errors or making suggestions that users change what
they had planned is balancing clinicians’ desire for auto no my with other demands, from or on
clinicians, such as improving patient safety or decreasing practice costs. Another question related
to autonomy is how much control users have over how they respond to the CDS. This aspect
of control relates to whether users are required to accept the CDS suggestion, whether they can
easily ignore it, or whether it takes significant effort to override the advice. Table 2 below
provides a summary of these points.