A Pragmatic Guide to Establishing Clinical Decision Support Governance and Addressing Decision Support Fatigue: a Case Study

Abstract

There is limited guidance available in the literature for establishing clinical decision support (CDS) governance and improving CDS effectiveness in a pragmatic, resource-efficient manner. Here, we describe how University of Utah Health established enterprise CDS governance in 2015 leveraging existing resources. Key components of the governance include a multi-stakeholder CDS Committee that vets new requests and reviews existing content; a requirement that proposed CDS is actually desired by intended recipients; coordination with other governance bodies; basic data analytics to identify high-frequency, low-value CDS and monitor progress; active solicitation of user issues; the transition of alert and reminder content to other, more appropriate areas in the electronic health record; and the judicious use of experimental designs to guide decision-making regarding CDS effectiveness. In the three years since establishing this governance, new CDS has been continuously added while the overall burden of clinician-facing alerts and reminders has been reduced by 53.8%.

Figure 1.

Clinician-facing medication alerts/visit.

Figure 2.

Clinician-facing BPAs/visit.

Figure 3.

Clinician-facing BPAs/visit stratified by introduction before or after CDS governance initiation.

Figure 4.

Clinician-facing pop-up BPA alerts/visit.

Figure 5.

Proportion of medication alerts followed by discontinuation of triggering drug within one hour.

Figure 6.

Proportion of clinician-facing BPAs with effective user interaction.

Figure 7.

Hepatitis C screening and screening status for patients born in 1945-1965. HM = Health Maintenance.