Table 1

Terminology and approaches used in clinical decision support system (CDSS) design

Design featureDescriptionExample
Interruptive alertPop-up; temporarily stops the primary task; requires acknowledgement or cancellation to continue.Drug allergy or drug interaction alerts.
Facilitative interruptive alertAs above but facilitates next steps by providing options for follow-on actions, for example, alternative choices.As above but suggests suitable alternative, for example, second-line antibiotic choice for patients with penicillin allergy.
Non-interruptive alertAlert that appears on screen but does not interrupt or stop the primary task.Sidebar presenting additional information that may be actioned after the primary task is complete.
Graded or tiered alertsAlerts (either interruptive or non-interruptive) that include information about the likelihood or severity of the risk associated with the information being presented.Contraindications graded as higher risk than precautionary warnings.
Drug dictionaryList of all the medicines available for prescribing.Commercial and non-commercial drug databases that facilitate choice of medicines to prescribe.
FormularyList of all the medicines available for prescribing in that organisation or for that user or patient group.Organisation-level formulary that restricts the choice of medicines available to prescribe.
Preference listSelection of medicines that are commonly or frequently prescribed by the user or user group.Preference list for acute admissions presenting with myocardial infarction, set at a system level, to nudge the user to prescribe by protocol.
Prepopulated doses or frequenciesRecommended dose or frequency is suggested when a medicine is selected; may be based on age or indication.Nudge to prescribe the appropriate low molecular weight heparin dose for prophylaxis.
Order setsStructured and standardised collection of orders for a given condition; usually based on evidence or guidelines.Postoperative medication orders for specific procedures to nudge the user to prescribe by protocol.
Forcing functionRequires action to progress, that is, restricts and prevents further actions until the issue has been addressed; often used in combination with interruptive or non-interruptive alerts.Mandatory entry of essential information, for example, entry of age for a paediatric prescription.