Table 7.

Taxonomy of clinical decision support (CDS) tools and survey results: expert systems

CDS type	CDS description	Example	Vendor							Total	Institution				Total	Grand total
			1	2	3	4	5	6	7		1	2	3	4
Expert systems
Antibiotic ordering support52	Antibiotic suggestions based on patient history, hospital antibiogram, culture results, and patient characteristics.	Suggest vancomycin for empiric antibiotic therapy for patients with suspected MRSA.	•				•			2	•	•		•	3	5
Ventilator support53	Ventilator suggestions based on patient-specific blood gas readings and current condition.	Unless the FiO2 is already at 1.0, suggest increasing the FiO2 by 0.1 if the PaO2 is >50 but <60 mm Hg in patients with acute respiratory distress syndrome.	•				•			2				•	1	3
Diagnostic support54 55	Differential diagnosis suggestions based on patient signs and symptoms (eg, Isabel, DxPlain, QMR)	Suggest a differential diagnosis of appendicitis, diverticulitis/osis, or kidney stones in patients with lower abdominal pain.		•		•				2	•				1	3
Risk assessment tools56	Tools and calculators to estimate disease risks based on patient characteristics.	Calculate 10-year cardiovascular disease risk for a patient based on the Framingham risk score.	•	•	•		•	•		5	•		•	•	3	8
Prognostic tools57	Tools to estimate the survival of patients with cancer or other potentially life-limiting conditions based on diagnostic criteria and procedures performed.	Estimate survival for cancer patients based on tumor type, location, staging, and procedures performed.	•				•			2	•				1	3
Transfusion support58	Recommendations regarding the appropriateness of transfusions and suggested products and dosing based on clinical indications.	Suggest fresh frozen plasma for patients with a high INR and taking warfarin.	•				•	•		3	•	•			2	5
Nutrition ordering tools59	Tools, calculators, guidelines, and protocols for ordering total parenteral nutrition (TPN), enteral nutrition or other alimentation procedures.	Suggest increased protein in TPN for patients with active infection.	•				•			2	•			•	2	4
Laboratory test interpretation60	Interpretative information for laboratory results. This may include reference range information, correlation among several results, or calculations (such as the anion gap).	Based on ABG values, report that a patient has high anion gap metabolic acidosis.	•	•			•			3	•		•	•	3	6
Treatment planning61	Computer tools to assist in the planning of interventional procedures (ie, surgery or radiation therapy).	An image-guided treatment planning system used for radiation oncology.					•			1	•		•		2	3
Triage tools62	Tools for determining urgency of clinical problems and sorting patients on the basis of need and available resources.	A computer prompt that recommends that a patient with facial numbness and slurred speech, as documented by a triage nurse, be seen immediately to rule out stroke.	•			•	•	•		4	•			•	2	6
Syndromic surveillance63	Direct or surrogate monitoring of disease conditions over a geographic area.	City-wide reporting and monitoring of emergency department chief complaints in order to detect norovirus outbreaks.	•					•		2	•			•	2	4
Totals: (absence of ‘•’ indicates response of N (no), NA (not applicable), or (blank))			9	3	1	2	9	4	0	28	10	2	3	7	22	50