The right information
Clinically appropriate, relevant content.
Institutional clinical informatics / Clinical decision support
Increase useful support.
Reduce unnecessary interruption.
CDS is the clearest example of the governance philosophy. Its clinical content, targeting, workflow, implementation, and evaluation require all three forms of intelligence.
The goal is more
useful CDS.
“Fewer alerts” is an incomplete goal. Useful decision support should expand, while unnecessary clinician-facing interruption falls. That requires specificity, context, workflow integration, and active lifecycle management.
Passive or embedded support can guide care without interrupting it. Interruptive alerts should be used deliberately. Poor-performing interventions should be reviewed, redesigned, or retired.
The Five Rights of CDS
The right person
The intended recipient in the care process.
The right format
An intervention suited to the need.
The right channel
The appropriate route for delivering it.
The right point in workflow
When the information can support action.
The Five Rights are an established CDS framework associated with Osheroff and colleagues. [4]
University of Utah Health / Published case study
53.8%
reduction in overall clinician-facing alert/reminder burden over three years, while new CDS continued to be added.
Governance can support
both goals.
University of Utah Health established enterprise CDS governance in 2015. Its approach combined multidisciplinary review, coordination with other governance bodies, analytics, active user feedback, and review of existing content.
It also considered whether intended recipients wanted an intervention, moved guidance to more appropriate places in the EHR, and used experiments selectively to resolve uncertainty.
This is a reported institutional case-study result, not a universal reduction target or proof that fewer alerts alone improve outcomes. Read the study.
Govern the whole
intervention lifecycle.
Every significant CDS intervention should have an owner, a clinical rationale, an intended outcome, a defined audience and workflow, and a plan for post-implementation evaluation.
Technical implementation, clinical appropriateness, usability, and domain-specific content each need the relevant expertise. Approval at one point in time should not make clinical content permanent.
Review performance and user experience after deployment. Refine an intervention when its targeting or delivery is wrong; expand it when it provides value; retire it when it no longer performs as intended.