Table 5.

Taxonomy of clinical decision support (CDS) tools and survey results: point of care alerts/reminders

CDS type	CDS description	Example	Vendor							Total	Institution				Total	Grand total
			1	2	3	4	5	6	7		1	2	3	4
Point of care alerts/reminders
Drug–condition interaction checking33	Checking medication orders against the patient problem list for possible contraindications.	Alert when a provider orders propranolol for a patient with asthma.	•	•	•	•	•	•	•	7	•	•			2	9
Drug–drug interaction checking34	Checking medication orders and the medication list for possible contraindications.	Alert when a provider orders sildenafil for a patient with nitroglycerin on the medication list.	•	•	•	•	•	•	•	7	•	•	•	•	4	11
Drug–allergy interaction checking35	Checking medication orders against the allergy list for possible contraindications, including both direct allergies, allergies to drug classes or ingredients, and cross-sensitivities.	Alert when a provider orders amoxicillin for a patient with a documented penicillin allergy.	•	•	•	•	•	•	•	7	•	•	•	•	4	11
Plan of care alerts36	Time-based alerts relating to plans of care.	Reminders to reassess the need for restraints and reorder if necessary at least every 24 h.	•		•	•	•			4	•	•	•		3	7
Critical laboratory value checking37	Comparing laboratory results to reference ranges and alerting providers to critical (panic) values.	Page the covering provider when pH>7.60.	•	•	•	•	•			5	•	•	•	•	4	9
Duplicate order checking38	Checking active medication orders and the medication list for possible duplication.	Alert when a provider orders metoprolol in a patient with an active order for atenolol or when it is already on the medication list.	•	•		•	•	•	•	6	•		•		2	8
Care reminders39	Reminders to order a diagnostic or therapeutic procedure based on patient parameters, including preventive care reminders, chronic disease reminders, or palliative care reminders.	Order an HbA1c every 6 months for patient with diabetes.	•	•	•	•	•	•	•	7	•	•	•	•	4	11
Look-alike/sound-alike medication warnings40	Warn providers when they order a medication whose name looks or sounds like another drug.	Warn providers ordering Zyrtec (cetirizine) or Zyprexa (olanzapine) to ensure that they have chosen the drug they intended.	•				•			2	•				1	3
Ticklers41	Time-based alerts that an order has not been fully carried out.	Alert a provider when a mammogram has been ordered but not scheduled or performed after 14 days.	•		•	•	•			4	•				1	5
Problem list management42	Alerts, reminders, and automated documentation tools that help providers maintain an accurate problem list.	When ordering ritonavir, ask the provider if he/she would like to add HIV to the problem list if not already documented.	•		•		•	•		4	•				1	5
Radiology ordering support43	Assistance in selecting appropriate radiology studies based on patient conditions.	Order a foot (rather than an ankle) x-ray if there is any pain in the midfoot zone and the patient is unable to weight bear both immediately and in the emergency department.	•	•	•		•	•		5	•	•		•	3	8
Intravenous (IV)/per os (PO) conversion44	Conversion of patients from IV agents to PO agents when clinically appropriate and cost-effective.	Convert patient from IV metronidazole to PO metronidazole when patient is no longer NPO (nil per os).	•					•		2	•	•			2	4
High-risk state monitoring45	Alerting the provider to high-risk states.	Alert the provider to order contact precautions for patients with known MRSA colonization.	•				•	•		3	•	•	•	•	4	7
Polypharmacy alerts46	Alerting the provider when patients are on a high number of medications.	Alert the provider that a patient is on >8 medications and suggest consult pharmacy.	•				•			2			•		1	3
Totals: (absence of ‘•’ indicates response of N (no), NA (not applicable), or (blank))			14	7	9	8	13	9	5	65	13	9	8	6	36	101