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. I NTRODUCTION E VEN though more than 50 years of research have been put 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 978-83-60810-22-4 978-83-60810-22-4/$25.00 c  2011 IEEE 347