What are Clinical Decision Support (CDS) advisories?

Upon opening the new encounter, each patient's record is quickly run through a database which searches for specific criteria and determines whether the patient requires an intervention. If the patient requires an intervention, one or more yellow alerts will appear at the top of the encounter.

 
Meaningful Use
Clinical Decision Support alerts also relate to one of the Medicaid Meaningful Use objectives. Providers who are completing Meaningful Use must have: 
Although you may adjust which advisories are enabled at any time, at least 5 advisories must be enabled at all times during the entire reporting period in order to meet this objective.

Configure and Customize your CDS Advisories
1. To configure CDS settings, click Settings in the top-right corner of your account.


2. Select CDS and Surveillance under the Notifications and alerts header.


3. Account administrators have the ability to configure practice-level settings, and all other users can configure their personal settings. Each Clinical Decision (CDS) notification can be individually updated by checking/un-checking the boxes on the right hand side.


Current CDS advisories
There are currently over 20 alerts that may be triggered, many of which are outlined below. 
  • Documentation of Current Allergies:
    Patient’s drug allergies are not documented or "No known drug allergies" has not been selected.
    Resolved by: Record the patient's drug allergies in the Allergies section, or select "No known drug allergies." Learn More
  • Documentation of Current Medications in the Medical Record:
    Patient is 18 years old or older without update of current medication list recorded for this encounter.
    Resolved by: Check the Documentation of medications box in the Quality of Care section. Learn more
  • Screening for Clinical Depression and Follow-Up Plan:
    Patient is 12 years old or older and not screened for clinical depression.
    Resolved by: Order or record an Adult depression screening assessment or an Adolescent depression screening assessment in the Screenings/Interventions/Assessments section and select one of the two results "Depression Screening Negative" or "Depression Screening Positive". If a positive result is indicated, perform and record one of the following follow-up plan. Learn More
  • Additional evaluation for depression
  • Follow-up for depression
  • Referral for depression
  • Suicide Risk Assessment
  • Medication order for depression medication
  • Diabetes: Hemoglobin A1c Poor Control:
    Patient is 18-75 years old with diabetes whose most recent structured lab result had a hemoglobin A1c > 9.0%, or does not have a hemoglobin A1c structured lab result (with a numeric result) within the past year.
    Resolved by: Patient receives a new structured lab result with A1c levels < 9.0%. Learn more
  • Diabetes: Foot Exam:
    Patient is 18-75 years old with diabetes and due for foot exam.
    Resolved by: Record a Diabetic foot exam (visual, sensory, and pulse)  in the Screenings/Interventions/Assessments section with a status of Performed. Learn More
  • Diabetes: Eye Exam:
    Patient is 18-75 years old with diabetes and due for retina exam.
    Resolved by: Record a Examination of the retina (procedure) in the Screenings/Interventions/Assessments section with a status of PerformedLearn More
  • Controlling High Blood Pressure:
    Patient is 18-85 years old with a diagnosis of hypertension whose blood pressure is not adequately controlled.
    Resolved by: The advisory will be removed once the patient's current blood pressure entry is less than 140/90 mmHg or the diagnoses of hypertention has been resolved. Learn more
  • Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up:
    Patients 18 years and older whose most recent BMI is outside of normal parameters.
    Resolved by: Order or record an appropriate weight management follow up in the Screenings/Interventions/Assessments. Learn More
  • COPD Management:
    Patient has COPD without spirometry result documented. Consider ordering and/or document spirometry results in labs (from patient’s Actions drop-down).
    Resolved by: Perform and/or document Spirometry lab result. From the Actions button in the upper-right corner of the encounter, select Enter Lab Result. Select the appropriate lab name. Search for the 'Spirometry' test and enter Spirometry lab FEV1/FVC result (%) and FEV1 Predicted. Learn More
  • COPD Management:
    Patient has COPD with FEV1<60% predicted and no bronchodilator recorded. Assess for the presence of respiratory symptoms and consider and/or document bronchodilator in Medication List.
    Resolved by: Click the Document medication link within the alert and document a bronchodilator in the patient's Medication List. Learn More
  • COPD Management:
    Patient has COPD and no bronchodilator recorded. Consider and/or document bronchodilator in Medication List.
    Resolved by: Click the Document medication link within the alert and document a bronchodilator in the patient's Medication List. Learn More
  • Asthma Management:
    Patient has asthma and no record of pharmacological treatment. Consider and/or document asthma medication(s) in Medication List. Asthma pharmacotherapy is defined as short-acting beta agonists (SABA), inhaled corticosteroids (ICS), OR alternative long-term control medication (inhaled steroid combinations, anti-asthmatic combinations, antibody inhibitor, leukotriene modifiers, mast cell stabilizers, methylxanthines).
    Resolved by: Click the Document medication link within the alert and document a short-acting beta agonist medication in patient's Medication List. Learn More
  • Asthma Management:
    Patient has asthma and should be evaluated for a long-term control medication. Consider and/or document asthma long-term control medication(s) in Medication List. Asthma long-term control medication includes inhaled corticosteroids (ICS) OR alternative long-term control medication (inhaled steroid combinations, anti-asthmatic combinations, antibody inhibitor, leukotriene modifiers, mast cell stabilizers, methylxanthines).
    Resolved by: Click the Document medication link within the alert and document a long-term control medication in the patient's Medication List. Learn More
  • Asthma Management:
    Patient has asthma and should be evaluated for asthma control every 6 months. Perform the childhood (age 4-11) or adult (age 12 years and up) Asthma Control Test in Screening/Interventions/Assessments.
    Resolved by: Click the Perform Assessment link within the alert and perform the Assessment Asthma Control Test. Learn More
  • Urinary incontinence
    Patient is a female over the age of 65 and should be assessed for urinary incontinence.

    Resolved by
    : Assess and document urinary incontinence in the Screenings/Interventions/Assessments by clicking the Assess patient link within the alert. Urine microscopy is indicated in the evaluation of urinary incontinence and should be free of hematuria or significant pyuria.  Learn More
  • Urinary incontinence
    Patient is over the age of 40 with a diagnosis of urinary incontinence. An appropriate care plan should be documented.

    Resolved by
    : Click the Record care plan link within the alert to discuss and document a care plan under Screenings/Interventions/Assessments. Learn More
  • Urinary incontinence
    Patient is over the age of 40 with a diagnosis of urinary incontinence and should undergo an evaluation to characterize the incontinence.

    Resolved by
    : Click the Record characterization link within the alert to characterize the patient’s urinary incontinence in the Screenings/Interventions/Assessments. Urine microscopy is indicated in the evaluation of urinary incontinence and should be free from hematuria or significant pyuria. Learn More
  • Vaccination reminders
    T
    he vaccination clinical decision support notifications are a part of our population health management program for adult vaccinations. Read more about population health management in Practice Fusion here.
    Resolved by
    : To resolve the adult vaccination CDS notification, document that the patient has received all of the appropriate vaccinations that they are eligible for, whether in the current visit or in the past, or document the appropriate health information in the EHR to indicate that the patient is excluded from receiving the recommended vaccinations. Learn More
  • Paroxysmal Nocturnal Hemoglobinuria
    T
    his patient has clinical markers considered high-risk for paroxysmal nocturnal hemoglobinuria (PNH) according to the International Clinical Cytometry Society (ICCS) guideline. Consider PNH flow cytometry to detect the absence or reduced expression of CD55 or CD59.
    Resolved by
    :
    Perform and/or document a PNH Flow Cytometry lab test using the Add a lab link within the alert. Learn More
  • Pompe Disease
    This patient has clinical markers that are considered high-risk for Pompe Disease. Consider ordering a GAA enzyme assay to confirm the absence or presence of the diagnosis.
    Resolved by: Consider ordering a GAA enzyme activity assay to confirm the absence or presence of the diagnosis.
  • Gaucher Disease
    This patient has clinical markers that are considered at risk for Gaucher Disease. Consider ordering a Gaucher enzyme assay to confirm the absence or presence of the diagnosis.
    Resolved by: Click the Order a lab link within the alert to order a Gaucher Disease Enzyme Assay (Glucocerebrosidase) and record the result.
  • Patient Safety
    Monitor and record adverse events of special interest that may be experienced in patients receiving Prolia. Learn More
    Resolved by: Click the Record link within the alert and confirm the patient’s Prolia history. If Prolia is a past and/or current medication (currently on or have taken within the past 16 months), record any adverse events listed in the questionnaire and report the adverse events to Amgen. Learn More
  • Fabry Disease
    This patient has clinical markers that are considered at risk for Fabry disease. Consider ordering a GLA Gene Mutation Analysis to confirm the absence or presence of the diagnosis.
    Resolved by: Click the Order a lab link within the alert to order a GLA Gene Mutation Analysis and enter either the results or a diagnosis of Fabry in the patient's chart.
     
  • Headache Quality of Life (QOL)
    Patient has clinical markers associated with primary headache disorder or migraine and should be assessed at least twice a year. Perform the MIDAS (Migraine Disability Assessment) in Screening/Interventions/Assessments.
    Resolved by:
    Click the Assess Patient link within the alert to complete the Migraine Disability Assessment (MIDAS) test to help determine the level of pain and disability caused by your patient’s headaches. If the test was not completed, select Not performed. Learn More
  • HCV Screening
    Patient has clinical markers indicating Hepatitis C screening may be appropriate. Consider ordering a HCV antibody test with reflexive viral RNA test.
    Resolved by:
    Click the Order a lab link within the alert to order a HCV antibody test with reflexive viral RNA test from your preferred lab. With this testing, the lab will first test for HCV antibody. If the result is reactive, the laboratory will automatically perform an HCV RNA test. Learn More
  • Osteoporosis Screening
    The USPSTF recommends screening for osteoporosis in women aged 65 to 85. Consider ordering DXA or document results.
    Resolved by:
    Click the Document DXA results link within the notification. Click Enter DXA result to document an imaging result for a DXA screening of the hip or spine. If the patient doesn’t already have an order for a DXA screening, click Order DXA to order the DXA imaging study of the hip or spine, then enter the results. Learn More
Diagnostic/Therapeutic Information Links
Diagnostic and therapeutic information links, also known as Infobuttons, are available within select CDS notifications to help providers access clinically relevant resources based on the subject of the alert, patient demographics, and clinical characteristics. Infobutton resources may provide additional insight on medical conditions and treatment guidelines, and can also serve as patient education materials. Providers can configure the Infobutton content source that is linked from CDS notifications to help ensure that providers are accessing the most relevant information for their patients. To learn more, see What is the Infobutton Configuration Setting?

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  32. What are Clinical Decision Support (CDS) advisories?
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  66. Why am I seeing CCDA display errors?
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