HAC Clinical Decision Support Systems 3 — Questions and Answers
Question 1: Which governance body is typically responsible for reviewing and approving new CDSS alerts before deployment in a hospital?
- Hospital finance committee
- Clinical informatics or pharmacy and therapeutics committee (Correct answer)
- Joint Commission accreditation team
- Health information exchange board
Correct answer: Clinical informatics or pharmacy and therapeutics committee
Clinical informatics committees or pharmacy and therapeutics committees typically govern CDSS content, reviewing evidence, clinical appropriateness, and workflow impact before deployment.
Question 2: A CDSS uses a Bayesian network to estimate sepsis probability. What is the main advantage of this approach over a simple rule-based system?
- It eliminates the need for laboratory data
- It can quantify uncertainty and update predictions as new data arrives (Correct answer)
- It does not require any training data
- It generates natural language explanations automatically
Correct answer: It can quantify uncertainty and update predictions as new data arrives
Bayesian networks can represent probabilistic relationships and update predictions dynamically as new clinical data becomes available, handling uncertainty more rigorously than deterministic rules.
Question 3: What does 'alert tiering' mean in CDSS design?
- Categorizing alerts by severity so high-risk alerts are more interruptive than low-risk ones (Correct answer)
- Scheduling alerts to fire only during day shift hours
- Filtering alerts based on patient insurance tier
- Routing alerts to different EHR modules based on specialty
Correct answer: Categorizing alerts by severity so high-risk alerts are more interruptive than low-risk ones
Alert tiering assigns different interruption levels—such as hard stops, soft stops, or informational banners—based on clinical severity to reduce alert fatigue while preserving attention for critical warnings.
Question 4: Which regulatory framework most directly governs clinical decision support software that qualifies as a medical device in the US?
- HIPAA Privacy Rule
- FDA 21st Century Cures Act provisions on software (Correct answer)
- CMS Conditions of Participation
- ONC Information Blocking Rule
Correct answer: FDA 21st Century Cures Act provisions on software
The 21st Century Cures Act established criteria distinguishing non-device CDS software from software requiring FDA oversight as a medical device, based on its intended use and decision autonomy.
Question 5: A CDSS recommends antibiotic selection based on local antibiogram data. Which type of clinical knowledge does this primarily represent?
- Patient-specific knowledge
- Population-level contextual knowledge (Correct answer)
- Regulatory compliance knowledge
- Administrative billing knowledge
Correct answer: Population-level contextual knowledge
Local antibiogram data represents population-level contextual knowledge about regional pathogen resistance patterns that informs clinical decisions for individual patients.
Question 6: During a post-implementation review, a CDSS drug interaction alert is found to have a 95% override rate. What is the MOST appropriate next step?
- Increase the alert's interrupt level to a hard stop
- Retire or redesign the alert to improve specificity or clinical relevance (Correct answer)
- Require written justification for all future overrides
- Expand the alert to fire for additional drug combinations
Correct answer: Retire or redesign the alert to improve specificity or clinical relevance
A 95% override rate indicates the alert lacks clinical value and is contributing to alert fatigue; it should be retired or redesigned to target only genuinely high-risk scenarios.
Question 7: Which of the following is a key challenge when implementing CDSS across multiple facilities within a health system?
- Ensuring each facility uses the same color scheme in the EHR
- Standardizing data definitions and local value sets across sites (Correct answer)
- Limiting all CDS rules to a single clinical specialty
- Requiring all facilities to share the same patient population
Correct answer: Standardizing data definitions and local value sets across sites
Variation in local data definitions, coding practices, and value sets across facilities can cause the same CDS rule to behave inconsistently, requiring careful standardization efforts.
HAC Clinical Decision Support Systems 3
Which governance body is typically responsible for reviewing and approving new CDSS alerts before deployment in a hospital?