CHAPTER ■ CLINICAL DECISION SUPPORT JOSEPH J ZORC, NAVEEN MUTHU Clinical decision support (CDS), broadly considered, encompasses any system, device, or document that is intended to support decision making by any individual involved in providing or receiving health care CDS has existed as long as clinical decisions have been made, and covers a wide variety of tools in the acute pediatric setting ranging from algorithms such as resuscitation guidelines or clinical pathways, devices such as measurement tapes for dose calculation, or complex smartphone applications to make diagnoses or apply clinical decision rules at the bedside More recently, CDS has become a focus within the field of clinical informatics, where it has been defined by Osheroff as content that “provides clinicians, staff, patients, or other individuals with knowledge and personspecific information, intelligently filtered or presented at appropriate times, to enhance health and health care.” Academic research and quality improvement work has often focused on CDS within the electronic health record (EHR), given its widespread recent adoption and central role within systems of clinical care However, the EHR is only one of many channels available to provide CDS PEOPLE, PROCESS, THEN TECHNOLOGY When considering an opportunity to use CDS to improve clinical care, the first step is to develop a team and identify the appropriate individuals who can best lead, inform, implement and sustain the project An adage within clinical informatics is the importance of focusing on people and process analysis before launching a proposed technology solution Much as erecting a building relies on a solid foundation, good CDS rests on an informed understanding of the individuals who will interact with the potential system, including their knowledge, attitudes, beliefs and limitations These team members can then map out the current state of the clinical process to provide a baseline for proposed interventions In parallel, understanding the goals of stakeholders and leadership will create champions and investment in resources that will be critical to CDS implementation and sustenance