Clinical decision support in cardiovascular medicine.

Despite considerable progress in tackling cardiovascular disease over the past 50 years, many gaps in the quality of care for cardiovascular disease remain. Multiple missed opportunities have been identified at every step in the prevention and treatment of cardiovascular disease, such as failure to make risk factor modifications, failure to diagnose cardiovascular disease, and failure to use proper evidence based treatments. With the digital transformation of medicine and advances in health information technology, clinical decision support (CDS) tools offer promise to enhance the efficiency and effectiveness of delivery of cardiovascular care. However, to date, the promise of CDS delivering scalable and sustained value for patient care in clinical practice has not been realized. This article reviews the evidence on key emerging questions around the development, implementation, and regulation of CDS with a focus on cardiovascular disease. It first reviews evidence on the effectiveness of CDS on healthcare process and clinical outcomes related to cardiovascular disease and design features associated with CDS effectiveness. It then reviews the barriers encountered during implementation of CDS in cardiovascular care, with a focus on unintended consequences and strategies to promote successful implementation. Finally, it reviews the legal and regulatory environment of CDS with specific examples for cardiovascular disease.
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: HMK has received personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, F-Prime, Siegfried & Jensen Law Firm, Martin/Baughman Law Firm, and Arnold and Porter Law Firm and grants from Johnson & Johnson; he is a co-founder of HugoHealth, a personal health information platform, and co-founder of Refactor Health, an enterprise healthcare artificial intelligence-augmented data management company, and he has contracts from Centers for Medicare & Medicaid Services Contracts, through Yale New Haven Hospital, to develop and maintain performance measures that are publicly reported outside the submitted work; YL is supported in part by the National Heart, Lung, and Blood Institute (K12HL138037) and the Yale Center for Implementation Science; ERM is supported in part by the National Institute On Drug Abuse of the National Institutes of Health under Award Number UH3DA047003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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