Standards for scalable clinical decision support: need, current and emerging standards, gaps, and proposal for...

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Healthcare Standards

Background:

• Advanced clinical decision support (CDS) offers significant healthcare improvement potential but faces limited clinical adoption.
• Current CDS implementations are often application-specific and institution-specific, hindering scalability.

Purpose of the Study:

• To highlight the critical need for developing and adopting standards to enable large-scale leveraging of CDS resources across diverse applications and care settings.
• To identify essential standards for effective CDS scaling, including terminology, information models, knowledge representation, and cross-setting application.

Main Methods:

• Review of existing and developing standards for health data representation, clinical knowledge formatting (human-readable and machine-executable), and CDS application across settings.
• Analysis of challenges and gaps in current standards development and adoption.

Main Results:

• Standards are emerging for health data, clinical knowledge, and CDS application.
• Significant challenges persist, including excessive standard complexity, limited availability of standard-based knowledge resources, and a lack of practical adoption tools.

Conclusions:

• Future widespread adoption of CDS standards hinges on the availability of supportive tooling and knowledge bases.
• Adopting standardized CDS approaches must become not only the correct but also the cost-effective path compared to traditional, ad hoc methods.