Evolving technology and regulations in healthcare mean more software acronyms to remember: EMR, PHR, EHR and now CDS. But CDS tools aren’t a new fad. Papers dating back to the 60’s recognized the importance of clinical decision support (CDS) tools to aid smarter, quicker decisions and reduce doctors’ cognitive load.

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Before adding new workflows and processes (and facing the ire of your clinicians), you’ll want to know what you’re getting yourself into. In this article, we’ll explain the different types of CDS tools, their importance, top products, examples of successful implementation and common challenges.

Article Roadmap

• What Are CDS Tools?
• Types
• Best CDS Tools
  • Micromedex
  • Zynx Health
  • UpToDate
  • Epocrates
  • PEPID Connect
• Benefits
• Case Studies
• Challenges
• Next Steps

What Are CDS Tools?

CDS tools are aids used by clinicians to optimize care delivery by providing assistance for diagnostics, resources, dosing and next steps. It’s utilized at point of care and helps improve patient outcomes by providing the right information on what is true and what to do.

Types

While all CDS tools are designed to optimize patient care, not all of them follow the same script. Like calling on doctors from multiple specialties during a complicated consult, each type of CDS tool offers a different facet to the decision-making process. Broadly, there are five types of CDS tools:

Medication Dosing Support

Potential drug interactions are an avoidable issue often caused by changes in medication during hospitalization. Computerized physician order entry (CPOE) with CDS alerts for dosing, duplication and DDI checking improves patient safety.

Dr. John Anhalt, Attending Physician, Cataract and Primary Eye Care at Will’s Eye Hospital, utilizes CDS tools for medicine reconciliation.

Clinical decision support (CDS) tools, which are often embedded in EMRs, have become essential to our practice. A good example of their utilization would be with medicine reconciliation. Older patients often have numerous medications that not only have adverse cross-reactions but can also affect how new medications are metabolized.

A CDS tool instantaneously cross-checks medications, avoiding drug toxicities and ensuring the patient receives the correct therapeutic dosing. This not only improves patient care but also saves valuable clinician time.

Order Sets

Another application involves setting up order sets around an objective or clinical problem with well-defined clinical pathways. Its usage is best for narrow, standard procedures as opposed to open-ended clinical situations.

Point of Care Alerts and Reminders

Notifying clinicians with helpful alerts and data to guide decisions is the modus operandi of this type of CDS tool. It uses passive or active reminders to alert clinicians to allergies, drug interactions, vaccine reminders and critical lab results.

Diagnostics Support

Machine learning and AI are game changers in the diagnostics space. Use AI models to aid diagnostic imaging interpretation. Access potential diagnoses for patient conditions using patient data, combined lab results and a pre-established medical knowledge database.

Info Buttons and Reference Guides

Having the right information at the right time is key to making the right decisions. Use integrated links and resources to access disease-specific references, medical calculators and treatment guidelines.

Best CDS Tools

The right CDS reduces clinicians’ workload, improves patient outcomes and speeds up processes. But, like choosing a specialty, weighing the pros and cons is vital. We crunched the numbers and came up with the top CDS tools to give you a leg up.

Product	Software Delivery Model	Free Trial	Company Size	Starting Price
	Cloud-Based	No	S M L	$9.99
	Cloud-Based	No	S M L	N/A
	Cloud-Based	No	S M L	$500
	Cloud-Based	Yes	S M L	$174.99
	Cloud-Based	No	L	$299.95

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Micromedex

Micromedex is a standalone solution that provides accessible clinical guidelines and information to care teams. Users can improve patient outcomes with updated content on drug interactions and comparisons, IV compatibility, and medical calculators to guide treatment. It also offers EHR integration and a mobile and web app.

Micromedex’s Research Database. Source

Top Benefits

• Improve Accuracy: Use cognitive computing to ascertain search intent, find clinical answers and recommend evidence to clinicians. Identify ingredients and toxicology information for commercial and pharmaceutical substances and check for drug interactions.
• Enhance Accessibility: Access evidence-based content offline using the mobile app. View drug summaries CareNotes and DrugNotes with API integration.
• Increase Efficiency: Streamline formulary management with online, organization-wide communication on current information and updates.
• Access In-Depth Insights: View customizable patient educational materials on conditions, diagnoses, labs and procedures at every stage of care.

Primary Features

• Drug Interactions Tool: Identify interacting drug ingredients, check effects and determine clinical significance. Get immediate access to drug-drug, drug-food, drug-ethanol and drug-lab test reactions.
• IV Compatibility Tool: Avoid adverse drug combinations and administer drug combinations safely using Trissel’s 2 IV compatibility tool and parenteral compatibility.
• InfoButton: View context-specific links with additional information on details and references in patient records.
• Drug Comparisons: Access side-by-side analysis of different pharmaceuticals with information on dosage, administration, contraindications, precautions and adverse effects.
• Toxicology and Drug Search Engine: Look up product, manufacturer contact, and related toxicologic management information. Identify ingredients for numerous commercial, pharmaceutical, and biological substances
• Medical Calculators: Use multiple medical calculators, including antidote and dosing calculators and nomograms, lab values, dosing tools, clinical calculators and measurement calculators to guide treatment.

Limitations

• Doesn’t support communication between pharmacists and nurses.
• Inability to find formulary status when not aligned with generic descriptions.
• Broad single-term search.

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Zynx Health

Zynx Health is a cloud-based suite solution designed to help skilled nursing facilities, managed care organizations and home health agencies deliver evidence-based care. Users can access order sets and care plan libraries with actionable interventions and recommendations to standardize care.

It also provides insights into order sets and care plan interventions to pinpoint and resolve knowledge gaps. EHR integration, multiple dashboard views and a web app optimize operations.

Zynx Health Content Explorer. Source

Top Benefits

• Improve Patient Outcomes: Stay up-to-date on critical guidelines and recommendations using ongoing surveillance of guideline organizations and regulatory bodies. Use the care plan catalog to manage complex cases and customize treatment to match unique factors.
• Boost Collaboration: Communicate between multiple care providers in real-time via a secure mobile app. Collaborate on care and treatment plans and streamline patient care post-discharge.
• Increase Traceability: View changes in audit logs and historical data to justify timings and rationale behind modifications. Verify adherence to accreditation requirements and collate supporting documentation for audits.

Primary Features

• Knowledge Analyzer: Compare order sets, care plans, protocols, rules and policies and procedures against comprehensive checklists using automation. Access easy-to-follow reports and identify recommended changes in clinical content.
• Dashboards: View key insights and trends using dynamic data visualization and three dashboard views: assessment comparison, guideline update and reviewer activity.
• Smart Assessments: Automate pre-visit interviews and clinical documentation using personalized assessment tools that factor in patient-specific details. Gather patient information to align their goals and recommended chronic care action plans.
• Care Plans: Customize care plans using care plan catalogs, patient condition and external factors.
• Content Management: Manage and deploy content using edits, group review and independent consensus building. Include evidence-based content in EHRs to help nurses make informed decisions.
• EHR Integration: Avoid data transfers and human errors by integrating with AllScripts, Epic, Cerner, Meditech, and McKesson.

Limitations

• Lacks robust reporting capabilities for the knowledge analyzer.
• Doesn’t include evidence-based order sets for all categories.
• Doesn’t support automation for care plans.

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UpToDate

UpToDate is a SaaS-hosted solution designed to improve evidence and clinical guidance for home health agencies, hospitals, labs and pharmacies. Users can access the latest guidance and best practices from over 25 specialties, with contributions from 7,400 physician authors and editors.

It helps users check drug interactions, search for relevant content, interpret abnormal results and navigate complex decisions.

UpToDate Interactive Pathways. Source

Top Benefits

• Optimize Formulary Management: Integrate with Formulink’s custom database service to view drug status, organizational restrictions, policies and procedures.
• Better Patient Engagement: Provide patients with 1,500 education topics to help them understand medical care decisions.
• Increase Flexibility: Access and update information without internet access using the mobile app.
• Improve Decision-Making: Integrate EHR workflows to add evidence-backed context and answers. Aid decision-making with interactive pathways.

Primary Features

• Unique Search Engine: Search for pictures, charts, movies and illustrations in multiple languages and graphic visualizations.
• Drug Interactions Tool: Identify drug-to-drug interactions with medication monographs and references from Lexicomp.
• Interactive Pathways: Navigate complex decisions and patient comorbidities and symptoms using interactive pathways.
• Lab Interpretation Monograph: Use decision trees to interpret lab results and determine the next steps for high-volume tests.
• Medical Calculators: Enter specific values to calculate data on patient levels, severity and risk factors.

Limitations

• Doesn’t provide graphic listing sentinel events in chronological order with anticipated normal age ranges.
• Inability to bookmark or create a favorites list.
• Doesn’t support highlighting or user-added annotation.

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Epocrates

Epocrates is a mobile medical reference tool for clinicians. It offers access to up-to-date disease information, details on alternative medicine, an interactions tracker and medical calculators. Users can receive medical news alerts, review clinical guidelines and access drug coverage information to improve decision-making.

Epocrates Bugs and Drugs Tool. Source

Top Benefits

• More Informed Point-of-Care: Review summaries of clinical practice guidelines, receive medical news alerts and access in-depth information on specialty topics to improve recommendations. Access real-time, geolocated information on bacterial types and resistance patterns specific to patients’ communities.
• Increase Efficiency: Use over 600 medical calculators, equations and risk scores and bookmark your most-used ones. Pull drug coverage for thousands of insurance plans categorized state-wise.
• Improve Information and Updates: Identify medications based on physical attributes with corresponding links and information using pill ID. Get safety and prescription information on thousands of drugs.

Primary Features

• Disease Information: Access comprehensive, peer-reviewed information developed in partnership with the BMJ Publishing Group. View history and exam details, initially recommended tests and additional tests to consider, differential diagnosis and treatment options.
• Lab Database: Monitor lab tests and panels with lab value ranges for different demographics. Review information on test preparation, collection guidance and differentials contributing to abnormal test results.
• Interaction Checker: Check potentially harmful interactions for up to 30 different drugs, herbs or supplements at a time. View detailed interaction profiles for each active ingredient of a drug product to modify or substitute treatment.
• Pill ID: Use visual analysis of shape, color, scoring and imprint code to identify pills. Generate a list of possible matches, including links and images to information in the database.
• Medical Calculators: Choose from over 600 medical calculators, equations and risk scores. Select your most-used tools as favorites.

Limitations

• Limited availability of features in the free version.
• Doesn’t provide hyperlinks to more detailed information.
• Lack of multi-language support.

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PEPID Connect

PEPID Connect is a suite solution to streamline diagnosing and dosing processes. Users can access comprehensive drug and medical content, care plan templates and calculators to help diagnose conditions, check allergies and harmful drug sensitivities and decide on treatment plans and doses. Its mobile app allows users to view content offline from remote devices.

PEPID Connect Mobile App.

Top Benefits

• Formulate Diagnoses Quicker: Generate a weighted list of potential diagnoses using a patient’s gender, age, symptoms, symptom severity, and the physician’s evaluation.
• Improve Patient Education: Engage and educate patients at the point of care with quick refs and patient handouts consisting of considerations, detailed information and contextual illustrations.
• Enhance Insights: Use the lab manual to see critical values and normal ranges. Check for conditions and medications associated with atypical levels of measured factors and access laboratory monographs alphabetically.
• Increase Efficiency: Personalize caregivers’ handheld clinical and drug references by bookmarking frequently visited pages. Create quick bedside notes and speed up communication with institution-wide alerts.

Primary Features

• Registered Nurse Care Plan: Create custom care plans using over 200 templates and linked clinical content and nursing considerations, including the complete collection of NANDA Diagnosis.
• Drug and IV Interaction Checker: Screen for potential drug interactions and view interaction summaries for medication lists. Check against over 100,000 drug products, 900 nutraceuticals and individual lifestyle factors. Optimize IV management and preparation by checking the compatibility of IV sites, drugs, and solutions.
• Dosing and Medical Calculators: Assess, prescribe, manage, and monitor treatments and ensure accurate dosing arithmetic, assessments, and screenings with over 3,000 dosing calculators.
• Adverse Drug Reaction Search Tool: Look up a drug’s adverse reactions, side effects, precautions, and essential information with patient and clinician views.
• Indications Checker: Alert healthcare professionals when patients shouldn’t use specific prescriptions with the Drug to Disease checker. Find alternative therapies, view labeled indications and common off-label uses and verify drug-indication compatibility.

Limitations

• Drug database updated quarterly.
• Inability to access database content once the subscription expires.
• Doesn’t support multiple languages.

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Primary Benefits

Adding another step to your clinicians’ workflow isn’t an easy decision. You need to be sure the pros outweigh the cons. Check out the benefits of implementing CDS tools below.

Improves Patient Safety

Avoid harmful drug interactions, irregular doses and allergies with alerts and notifications, medical calculators and reference tools. Access past patient data using EHR integration to view past conditions and medications and avoid adverse responses.

Streamlines Workflows

Improve processes to speed up care delivery using pre-set clinical pathways and evidence-based recommendations. Optimize workflows with decision support systems and order sets. Avoid switching from app to app with integrated medical guides, info buttons and patient records.

Reduces Cognitive Load

Reducing the cognitive load of clinicians is as close as you can get to finding a silver bullet. For Dr. Kevin Huffman, CEO and Founder of Ambari Nutrition, CDS tools help optimize care delivery with medical resources and next steps for care plans.

He noted:

As a bariatric physician and doctor of osteopathic medicine, I use Clinical Decision Support tools daily to improve patient care. I’ve integrated various CDS systems into my workflow, and the Epic Systems software decision support systems are particularly helpful.

I am able to cut through complicated diagnoses with preset decision support systems and then ask about the advice: Is the body of evidence for this advice current with the most recent research?

When you work in bariatric medicine, you often deal with other comorbidities on top of the main condition. These tools help you to have an expansive view, but also ensure that the advice is current so the clinical advice given to patients meets acceptable standards. CDS gives me the next step and supports me in customizing the treatment plan.”

Speeds Up Diagnostics

For the average primary care doctor, there just aren’t enough hours in the day to fulfill all patient care needs. CDS tools help lighten the load with computerized consultations that filter possible diagnoses, knowledge-based imaging to select tests to run and AI models that combine tests to interpret results.

Contains Costs

Running duplicate (or unnecessary) tests, readmitting patients due to adverse reactions or using expensive medications cost hospitals and patients a pretty penny. Minimize costs using alerts for duplicative services and machine learning and AI to predict patient conditions and recommend cheaper drug alternatives.

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Case Studies

Today, on Elon Musk’s internet, anyone can make a statement about CDS tools contributing to positive outcomes. But, if you’re like us, it takes evidence-backed examples to make a decision.

Mayo Clinic Statin Choice Decision Aid

Researchers at the Mayo Clinic developed the Statin Choice Decision Aid (SCDA) in 2007 to demonstrate the mitigated risk of adverse cardiovascular events among type two diabetes patients using statins. Deciding whether to administer treatment demands an intricate analysis of individual patient characteristics and risk-to-benefit tradeoffs.

The Statin Choice Decision Aid is an EMR-integrated tool. It works as an interactive risk calculator, completed with the patient to offer evidence-based analysis of the benefits of statin treatment. On average, it takes five minutes to complete, and results in patients making more informed decisions, saving clinician time.

Kidney Failure Risk Equation (KFRE)

It isn’t uncommon for EMRs to integrate nephrology CDS tools to calculate the risk of kidney failure. Chronic kidney disease is a global problem, but early treatment can delay or prevent adverse outcomes.

Using age, sex, estimated glomerular filtration rate and the urinary albumin-to-creatinine ratio, the KFRE offers an accurate predictive model for the progression of kidney failure.

Because three of the variables are easily accessible (excluding the urinary albumin-to-creatinine ratio), integration with EMRs can automate KFRE calculation, prompt clinicians to order urinary albumin-to-creatinine ratio testings, identify at-risk patients and improve provider workflows.

Challenges

Adding a shiny new tool to your EHR isn’t a decision you take without plenty of stakeholder input. It’s crucial to provide a complete picture. Here are some common challenges implementing a CDS tool may bring.

Alert Fatigue

Checking off dozens of alerts and notifications (many of which may not be relevant) can cause “alert fatigue” in clinicians. It can lead to what one doctor called “crying wolf” over too many drug interaction alerts. An inability to override irrelevant order sets or fields causes an alert overload and may result in missing important notifications.

High-Impact of Low-Quality Database

With machine learning and AI, the output is only as good as the input. A low-quality database may lead to clinicians receiving advice from peer-reviewed medical literature that may not adhere to established methodological standards. Evidence-adaptive CDS tools are necessary to improve decision support.

Lack of User Acceptance and Integration

Getting doctors and nurses on board is key to successful CDS implementation. Primary care professionals appreciate CDS tools that are well-integrated into clinical workflows. Receiving information or alerts irrelevant to their specialty or that went against their beliefs and the additional workload may act as a barrier to adoption.

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Next Steps

Scouting for new software can be more stressful than match day. We hope our research on the top CDS tools gives you a helpful starting point. Need another helping hand? Try our free requirements template to narrow down your desired features before shopping. Good luck!

How would the ideal CDS tools benefit your organization? Let us know in the comments below.

SME Contributors