Table 2.

Integration of CDS across the population, encounter, and precision care domains of LK, a hypothetical 68-year-old female patient with COPD.

Care management action	Associated CDSa level
LK is assigned a care management team (disease registry) that monitors her clinical status using annual office spirometry.	Population
After 3 years, longitudinal analytics alert LK’s care managers that her spirometry is declining and her symptoms are increasing.	Population
Based on this trend, the team schedules an appointment with her health care provider. The provider considers starting a long-acting beta-agonist alone, but when he tries to order one, he is prompted to start an inhaled corticosteroid in accordance with present guidelines.	Encounter
After 6 months, LK has a severe COPDb exacerbation. She contacts her care team through an EMRc, and they advise her to go to the emergency department.	Population
When LK is admitted to the hospital, the EMR recommends intravenous cefepime because she meets the criteria for complicated COPD based on her age of older than 65 years and a recent spirometry FEV1d measurement of less than 50% predicted. During her hospitalization, LK develops a rib fracture from coughing and has severe pain. A genomic analysis performed two years earlier as part of the institution’s precision medicine program determined that she had multiple copies of the CYP2D6 gene, indicating an increased likelihood of excessive sedation from codeine-containing cough syrups due to rapid conversion into morphine.	Encounter and precision
The hospitalist is alerted to her pharmacogenetic status and prescribes hydrocodone instead of codeine for management of pain and cough, and capnography monitoring is used to monitor for respiratory depression or failure.	Encounter and precision
LK is ready for discharge after 5 days. Based on her known COPD and hospitalization, the EMR recommends an influenza vaccine prior to discharge.	Population and encounter
The discharging team arranges follow-up with LK’s primary care provider. Her chronic care managers receive an alert that she is being discharged and contact her three days later. Through a video call, they learn that she is having trouble with daily activities due to deconditioning and the rib fracture. A home health evaluation is arranged, and physical therapy and home health nursing are prescribed. LK improves over the next 2 weeks and returns to her baseline surveillance schedule.	Population

^aCDS: clinical decision support.

^bCOPD: chronic obstructive pulmonary disease.

^cEMR: electronic medical record.

^dFEV₁: forced expiratory volume in first second of expiration.