Clinical Decision Support in Cardiovascular Medicine: Effectiveness, Implementation Barriers, and Regulation

Abstract

AbstractDespite considerable progress in addressing cardiovascular disease (CVD) over the past 50 years, there remain many gaps in CVD care quality. Multiple missed opportunities have been identified at every step in the prevention and treatment of CVD, such as failure to make risk factor modifications, failure to diagnose CVD, 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 cardiovascular care delivery. Yet, to date, the promise of CDS delivering scalable and sustained value for patient care in clinical practice has not been realized. Here, we review evidence on key emerging questions around the development, implementation, and regulation of CDS with a focus on CVD. We first review evidence on the effectiveness of CDS on patient health and health delivery outcomes related to CVD and features predictive of effectiveness. We then review the barriers encountered during CDS implementation in cardiovascular care with a focus on unintended consequences and strategies to promote successful implementation. Finally, we review the current legal and regulatory environment of CDS with specific examples for CVD.