HAC Clinical Decision Support Systems 2 — Questions and Answers
Question 1: Which CDSS architecture type embeds decision logic directly within the EHR workflow rather than as a separate application?
- Standalone CDSS
- Integrated CDSS (Correct answer)
- Federated CDSS
- Autonomous CDSS
Correct answer: Integrated CDSS
Integrated CDSS embeds decision logic within the EHR workflow, allowing alerts and recommendations to appear natively during clinical documentation.
Question 2: A CDSS alert fires every time a clinician orders aspirin for any adult patient. This is an example of which alert quality problem?
- False negative rate
- Alert fatigue from low specificity (Correct answer)
- Incomplete knowledge base
- Decision tree overfitting
Correct answer: Alert fatigue from low specificity
Low specificity causes alerts to fire too broadly, leading to alert fatigue when clinicians repeatedly override non-actionable notifications.
Question 3: In the context of CDSS, what does the term 'passive CDS' refer to?
- CDS that requires clinician to actively request information (Correct answer)
- CDS that automatically interrupts clinician workflow with alerts
- CDS that only runs during off-peak hours
- CDS that requires patient consent before activating
Correct answer: CDS that requires clinician to actively request information
Passive CDS provides information only when the clinician actively seeks it, such as through order sets or infobuttons, without unsolicited interruptions.
Question 4: Which metric best measures the proportion of CDSS alerts that result in a clinician changing their intended action?
- Sensitivity
- Override rate
- Positive predictive value
- Alert acceptance rate (Correct answer)
Correct answer: Alert acceptance rate
Alert acceptance rate measures the percentage of CDSS alerts that lead to a clinician modifying their clinical action, indicating real-world impact.
Question 5: A hospital wants to implement a CDSS rule to flag patients at risk for acute kidney injury. Which data element is MOST critical for this rule?
- Patient zip code
- Serum creatinine trend (Correct answer)
- Attending physician specialty
- Insurance authorization status
Correct answer: Serum creatinine trend
Serum creatinine trend is the key biomarker for detecting acute kidney injury, as rising creatinine levels indicate declining renal function.
Question 6: What is the primary purpose of CDS Hooks in modern healthcare interoperability standards?
- To encrypt clinical data during transmission
- To enable EHR systems to call external CDS services at defined workflow points (Correct answer)
- To synchronize patient records across health information exchanges
- To automate prior authorization requests with payers
Correct answer: To enable EHR systems to call external CDS services at defined workflow points
CDS Hooks is an HL7 standard that allows EHR systems to invoke external CDS web services at specific workflow moments and display results within the EHR.
Question 7: Which of the following BEST describes a knowledge artifact in clinical decision support?
- A log file recording all clinician overrides
- A computable representation of clinical knowledge such as a rule or guideline (Correct answer)
- A scanned image of a paper-based clinical protocol
- A database of ICD-10 billing codes
Correct answer: A computable representation of clinical knowledge such as a rule or guideline
A knowledge artifact is a structured, computable representation of clinical knowledge—such as an if-then rule, order set, or care plan template—used by a CDSS to generate recommendations.
HAC Clinical Decision Support Systems 2
Which CDSS architecture type embeds decision logic directly within the EHR workflow rather than as a separate application?