Below is an introduction to AHRQ’s CDS program and useful links to AHRQ CDS resources.
What is CDS, and why is it important?
CDS is a digital tool that provides timely information to help inform decisions about a patient's care, improve patient outcomes, and lead to higher quality health care. CDS can take place in many settings, including the point of care, and can take many forms, ranging from order sets and patient summary dashboards to advanced tools that incorporate large amounts of patient data to assist with diagnosis and treatment. CDS can potentially lower costs, improve efficiency, and reduce patient inconvenience. In fact, CDS can sometimes address all three of these areas simultaneously—for example, by alerting clinicians about possible duplicate tests a patient may be about to receive.
What is patient-centered CDS, and how does it impact patient care?
In addition to “traditional” clinician-facing CDS, there is a type of CDS that focuses on the patient (or caregiver) – called patient-centered CDS, or PC CDS. This type of CDS facilitates a patient’s or caregiver’s active involvement in healthcare decision-making with their clinicians. PC CDS uses information from patient-centered outcomes research (PCOR) findings and/or patient-specific data to provide support for personalized health care and to empower patients. PCOR compares the impact of two or more preventive, diagnostic, treatment, or health care delivery approaches on health outcomes, including those that are meaningful to patients. AHRQ describes PC CDS in the infographic here, outlining how PC CDS significantly incorporates multiple patient-centered factors, including the areas of knowledge, data, delivery, and use. PC CDS is a developing field and has the potential to increase the quality and experience of patient care.
What is PCOR CDS at AHRQ?
AHRQ is legislatively mandated to do two things with respect to PCOR and CDS: (1) to incorporate research findings in a timely manner through CDS tools, while promoting the ease of use of these findings, and (2) to establish a process to receive feedback from physicians, health care providers, patients, and vendors of health IT who are focused on CDS. AHRQ must also assess the value of this information and how it is used. Aligned with other legislatively-mandated PCOR dissemination and training activities at AHRQ, the PCOR CDS program focuses on improving care by advancing PCOR findings into practice through CDS.
The CDS program is part of the Division of Digital Healthcare Research in AHRQ’s Center for Evidence and Practice Improvement. The CDS program’s activities are framed by four “pillars”: (1) Engaging a stakeholder community; (2) Creating a prototype infrastructure for sharing CDS and developing CDS; (3) Advancing CDS through grant-funded dissemination research; and (4) Evaluating the overall program, as shown in the graphic below.
The four pillars of AHRQ's PCOR CDS Initiative
Over the years, AHRQ’s PCOR CDS Program has completed several projects across a diverse landscape of healthcare needs from chronic pain and hypertension management to efforts to enhance personalization of care. Key projects in AHRQ’s PCOR CDS portfolio are shown below.
Key Projects
The CDS Connect project is a freely available web-based platform that enables the CDS community to identify evidence-based care, translate and codify information using an interoperable health IT standard, and leverage tooling to promote a collaborative model of CDS development. It was originally developed in partnership with the Health Federally-Funded Research and Development Center (FFRDC), operated by MITRE, and supported by AHRQ. CDS Connect has two components:
The CDS Connect Repository supports AHRQ’s mission to disseminate and implement PCOR findings into clinical practice through interoperable CDS. The Repository hosts numerous “knowledge artifacts,” which are resources shared by contributors for public re-use to lower the burden of developing CDS from scratch in other settings. Artifacts range from interoperable, standards-based algorithms to flow diagrams and reports about pilot implementations used in front-line community healthcare settings. Repository artifacts cover multiple clinical conditions in preventive and primary care as well as specialty care like ophthalmology and neurology. A variety of organizations contribute artifacts to the Repository, including other Federal agencies, like the Department of Veterans Affairs and the Centers for Disease Control and Prevention.
The CDS Authoring Tool, along with the Repository, is designed to promote the creation and use of CDS in everyday clinical settings. The CDS Authoring Tool provides an interface for creating CDS logic and exporting the logic as Health Level Seven (HL7) Clinical Quality Language (CQL). The CDS Authoring Tool leverages the HL7 Fast Healthcare Interoperability Resources (FHIR®) data model for integration with EHRs.
****Note: On April 28th, 2025, the CDS Connect Repository and Authoring tool will go offline while the CDS program realigns with new federal/agency priorities. For any other questions, please contact the clinical decision support team at clinicaldecisionsupport@ahrq.hhs.gov.
CDS innovation Collaborative (CDSiC)
https://cdsic.ahrq.gov/
The Clinical Decision Support Innovation Collaborative (CDSiC) is a community of diverse stakeholders at the forefront of using technology to better support care teams, patients, and caregivers. The CDSiC is working toward healthcare decisions driven by both patient-centered and patient-specific information that aligns with patient needs, preferences, and values. The focus of the CDSiC is PC CDS.
Since 2021, the CDSiC has developed a portfolio of resources – patient-facing apps piloted in healthcare systems, frameworks and guides to understand and measure PC CDS, peer-reviewed publications, and other tools – to help advance the field of PC CDS. These resources serve a diverse audience including patients, clinicians, developers, and researchers. It conducts its research through the four workgroups in the Stakeholder Center (workgroups include: Measurement and Outcomes, Implementation, Adoption and Scaling, Trust and Patient-Centeredness, and CDS Standards and Regulatory Frameworks), and through two cores in its Innovation Center (cores include: Measurement and Value of CDS and Conducting and Coordinating CDS projects). The CDSiC also has an Operations Center, which manages a stakeholder-driven steering committee to provide feedback on the project as well as dissemination and outreach.
More information is available on the project website: https://cdsic.ahrq.gov
Key Projects and Resources
| Title | Link | Description |
|---|---|---|
| CDS Connect | Project description | The CDS Connect project is a freely available web-based platform that enables the clinical decision support (CDS) community to identify evidence-based care, translate and codify information into an interoperable health IT standard, and leverage tooling to promote a collaborative model of CDS development. It has two components, an authoring tool, and a repository.
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| CDSiC | Stakeholder Center Workgroup Products (begins mid-way down page) | The CDSiC is an ongoing learning collaborative that is advancing the concept of PC CDS by creating and disseminating resources and bringing together patients, developers, clinicians, and others through workgroups, demonstration projects, and an annual meeting. The CDSiC is strategically organized into 3 Centers.
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| PC CDS Learning Network | Project description | The Patient-Centered Clinical Decision Support Learning Network (PCCDS LN) was a multistakeholder collaborative that addressed barriers and facilitators around PC CDS, formulated recommendations, and worked to improve the adoption and use of PCOR-based CDS. It developed several publications and a final report (see publications tab). |
| PCOR CDS: Current State and Future Directions | Project description | This project designed and executed a comprehensive evaluation of the first few years of AHRQ’s PCOR CDS Program. It also conducted a horizon scan to explore current and future opportunities for PC CDS and two pilot projects to explore PC CDS implementation and future research. This project authored several publications (see publications tab). |
| CEDAR | Project description | Focused on dissemination of evidence-based research findings, the goal of CEDAR (CEPI Evidence Discovery and Retrieval) was to make PCOR findings more FAIR (findable, accessible, interoperable, and reusable) through technologies used by clinicians, researchers, implementers, patients, and others. Specifically, this work developed prototype infrastructure that demonstrated standards-based, application programming interface (API)-enabled discovery and retrieval of underlying PCOR findings within repositories in AHRQ’s Center for Evidence and Practice Improvement (CEPI). |
| CDS for Chronic Pain Management | These projects leveraged Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standards and contributed to HHS’s efforts to address the opioid overdose epidemic. The projects developed implementation guides and reusable, shareable CDS resources that were posted on the CDS Connect Repository and other platforms. See publications tab for RTI and Medstar. | |
| Quantifying Efficiencies Gained through Shareable CDS Resources | Project description | For this research, AHRQ contracted with MedStar Health Research Institute (National Center for Human Factors in Healthcare) to compare the CDS lifecycle in its current state (the “Isolated CDS Build”) to the future state (the “Shareable CDS Resources Build”) by using publicly available resources on the AHRQ CDS Connect platform. |
Grants
| Title | Link | Description |
|---|---|---|
| AHRQ-funded CDS Demonstration grants (U18) | NOFO: PA-18-792
HS 026849 (Oregon Health and Science University) HS 027099 (University of Utah) HS 027557 (Brigham and Women's Hospital) | These cooperative agreements focus on disseminating evidence into practice through shared, interoperable CDS resources. |
| AHRQ-funded CDS demonstration grants (R18) | NOFO: PA-20-074
R18 HS028584 (University of Florida) R18 HS028579 (Oregon Health and Science University) R18 HS028791 (University of Utah) R18 HS028583 (University of Minnesota) R18 HS028578 (University of Colorado, Denver) R18 HS028787 (University of Michigan at Ann Arbor) R18 HS028616 (Brigham and Women's Hospital) R18 HS029300 (University of Utah) R18 HS028955 (Ihc Health Services, Inc.) | These grants scale, disseminate, and implement PCOR evidence in clinical practice by scaling computer-based, interoperable CDS. |
| Other AHRQ-funded CDS research | Search for CDS-related projects in AHRQ’s Digital Healthcare Research portfolio | This pre-populated search finds additional CDS-related activities, including both grants and contracts, across AHRQ’s Digital Healthcare Research portfolio. |
Earlier AHRQ supported CDS research projects:
Structuring Care Recommendations for Clinical Decision Support
Challenges and Barriers to Clinical Decision Support Implementation
Clinical Decision Support Systems: State of the Art
The following archived AHRQ Annual Conference presentations on CDS are also available:
Use of Clinical Decision Support Tools to Facilitate Evidence-Based Patient Care – 2010
- The Cancer in the Family Clinical Decision Support Tool
Linda Squiers, RTI International
Structuring Clinical Recommendations for Clinical Decision Support – 2010
- Structuring Care Recommendations for Clinical Decision Support
Jerry Osheroff, Thomson Reuters
Clinical Decision Support Tools for Ambulatory Settings – 2008
- Clinical Decision Support Consortium
Blackford Middleton, Harvard Medical School
Value of Clinical Decision Support – 2007
- Influencing Patient Safety in Rural Primary Care Clinics Through Computerized Order Entry
Matthew Samore, VA Salt Lake City Health Care Systems/ University of Utah - Effective Decision Support: Lessons Learned in Community-Oriented Care
David Lobach, Duke University School of Medicine