The Intersection of Clinical Decision Support and
Electronic Health Record:
A Literature Review
Hajar Kashfi
Department of Applied Information Technology, Chalmers University of Technology
SE–412 96 Gothenburg, Sweden, Email: hajar.kashfi@chalmers.se
Abstract—It is observed that clinical decision support (CDS)
and electronic health records (EHR) should be integrated so
that their contribution to improving the quality of health care is
enhanced. In this paper, we present results from a review on the
related literature. The aim of this review was to find out to what
extent CDS developers have actually considered EHR integration
in developing CDS. We have also investigated how various clinical
standards are taken into account by CDS developers.
We observed that there are few CDS development projects
where EHR integration is taken into account. Also, the num-
ber of studies where various clinical standards are taken into
consideration in developing CDS is surprisingly low especially
for openEHR, the EHR standard we aimed for. The reasons for
low adoption of openEHR are issues such as complex and huge
specifications, shortcomings in educational aspects, low empirical
focus and low support for developers. It is concluded that there
is a need for further investigation to discover the reasons why
the rate of integration of EHRs and CDS is not at an optimum
level and mostly to discover why CDS developers are not keen
to adopt clinical standards.
I. INTRODUCTION
EVEN though more than 50 years of research have beenput into the clinical decision support (CDS) field, the
adoption rate of these systems is still low [1], [2], [3], [4],
[5], [6]. Various researchers have investigated the factors that
should be considered by developers of such systems in order to
result in higher adoption. One of these factors is the integration
of CDS into the electronic health record (EHR) systems.
Different benefits are associated with the integration of CDS
into EHRs. For instance, integration facilitates real time access
to the knowledge provided by CDS at point of care, it also
eliminates tedious duplicate patient data entry since the pre-
existing digital patient data in the EHR system can be utilized
for the purpose of providing decision support [1], [7], [8].
The aim of this study is to answer this research question: is
integration of clinical decision support into electronic health
record taken into consideration by developers of clinical
decision support? The related literature was reviewed not
only to explore CDS developers’ attitude towards integration
of EHR and CDS, but also to discover the status of EHR
standards in this field.
The structure of the paper is as follows. We start with
the background information including the motivation for
integration of CDS and EHRs in Section II. In Section III the
literature review search strategy is given. The results of the
review are presented in Section IV. Section V includes the
discussion of the findings along with our reflection on the low
adoption rate of the openEHR EHR standardization approach.
Finally, we end with a conclusion and future directions of
the study in Section VI.
II. BACKGROUND
The idea of computerized medical records has been around
as one of the key research areas in medical informatics for
more than 20 years. Iakovidis defines EHR as “digitally
stored health care information about an individual’s lifetime
with the purpose of supporting continuity of care, education
and research, and ensuring confidentiality at all times” [9].
EHRs include the whole range of patient-related data such
as demographic information, medical history, medication, and
allergies [10].
The main aim of EHRs is to make distributed and cooper-
ating health information system and health networks a reality
[10].
Several reasons have been identified for the low adoption
rate of EHRs in small hospitals and office practices. This
includes high implementation and maintenance costs, addi-
tional time and effort and finally the difficulty in choosing
among available systems on the market due to a lack of
standardization [1].
Improving the quality of health care is the ultimate goal of
the EHR research domain, but it is in doubt whether EHRs
have the ability to fulfill this goal [5]. EHRs need to be
supported by other services in order to improve the quality
of care [5], [11], [12], [13]. To reach the goal of improved
health care quality, it is central to have CDS [5], [14], [3],
[2], [6], [12], [15].
It has been observed that if there is no decision support
service, the clinical knowledge needed for making a deci-
sion is not always available or applied [16]. Therefore, it is
recommended that clinicians be automatically supported by
Proceedings of the Federated Conference on
Computer Science and Information Systems pp. 347–353
ISBN 978-83-60810-22-4
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