CDS Hooks Best Practices for EHR Vendors

Recommendations for EHR vendors implementing CDS Hooks to enable integration with external clinical decision support services.

While CDS Hooks is not currently required by ONC certification criteria, it is detailed in the proposed HTI-2 rule, indicating it will likely become a certification requirement in the future. It represents an important standard for clinical decision support integration that EHR vendors should prepare to implement.

CDS Hooks Client Implementation

Best practices for implementing CDS Hooks in your EHR

Support CDS Hooks 1.0 specification

Implement the latest version of the CDS Hooks specification to ensure compatibility with a wide range of CDS services.

Implement standard hook points

Support standard hook points such as patient-view, medication-prescribe, order-review, and appointment-book to enable integration with a variety of CDS services.

Support service discovery and registration

Implement a user-friendly interface for administrators to discover, register, and configure CDS services within the EHR.

Workflow Integration

Best practices for integrating CDS Hooks into EHR workflows

Implement efficient prefetch

Support prefetch capabilities to provide CDS services with the data they need, reducing latency and improving the user experience.

Support SMART app launch from cards

Implement the ability to launch SMART apps from CDS cards with appropriate context, enabling seamless integration of advanced decision support tools.

Support all suggestion action types

Implement support for all suggestion action types, including creating, updating, and deleting FHIR resources based on CDS recommendations.

Security and Error Handling

Best practices for secure and reliable CDS Hooks implementations

Implement SMART authorization

Use SMART on FHIR authorization for securing CDS Hooks services, ensuring that only authorized services can access patient data.

Handle service timeouts gracefully

Implement timeout handling to ensure that EHR workflows can continue even if a CDS service is slow to respond or unavailable.

Provide service monitoring

Implement monitoring capabilities to track CDS service performance, availability, and usage patterns to help administrators identify and resolve issues.

User Interface Integration

Best practices for displaying CDS cards in the EHR

Implement non-intrusive card display

Display CDS cards in a way that provides valuable information without disrupting clinical workflows or creating alert fatigue.

Support card dismissal and send feedback to CDS servers

Implement mechanisms for users to dismiss cards and provide feedback on their relevance. Crucially, send this feedback to the CDS service providers when users accept or dismiss recommendations, enabling them to improve their algorithms and the quality of future recommendations.

Support card prioritization

Implement a system for prioritizing and organizing CDS cards based on clinical importance, urgency, and relevance to the current workflow.