Clinical Decision Support in Cardiovascular Medicine: Promise, Barriers, and Regulatory Landscape
This BMJ review examines how clinical decision support (CDS) tools can address persistent quality gaps in cardiovascular care, from missed risk factor modifications to underuse of evidence-based treatments. The authors evaluate design features associated with CDS effectiveness, catalog implementation barriers including alert fatigue and unintended consequences, and review the evolving legal and regulatory environment. Despite advancing health IT infrastructure, the review concludes that scalable, sustained clinical value from CDS remains largely unrealized.
The original study
Clinical decision support in cardiovascular medicine.
- Authors
- Lu Y, Melnick ER, Krumholz HM
- Journal
- BMJ (Clinical research ed.)
- Type
- Journal Article, Review
- PMID
- 35613721
Original abstract
Despite considerable progress in tackling cardiovascular disease over the past 50 years, many gaps in the quality of care for cardiovascular disease remain. Multiple missed opportunities have been identified at every step in the prevention and treatment of cardiovascular disease, such as failure to make risk factor modifications, failure to diagnose cardiovascular disease, and failure to use proper evidence based treatments. With the digital transformation of medicine and advances in health information technology, clinical decision support (CDS) tools offer promise to enhance the efficiency and effectiveness of delivery of cardiovascular care. However, to date, the promise of CDS delivering scalable and sustained value for patient care in clinical practice has not been realized. This article reviews the evidence on key emerging questions around the development, implementation, and regulation of CDS with a focus on cardiovascular disease. It first reviews evidence on the effectiveness of CDS on healthcare process and clinical outcomes related to cardiovascular disease and design features associated with CDS effectiveness. It then reviews the barriers encountered during implementation of CDS in cardiovascular care, with a focus on unintended consequences and strategies to promote successful implementation. Finally, it reviews the legal and regulatory environment of CDS with specific examples for cardiovascular disease.