Clinical Decision Support (CDS) is a cornerstone of modern health informatics, providing clinicians with timely, patient-specific information to enhance decision-making and improve care. For pharmacists, CDS is a critical tool for ensuring medication safety and optimizing therapy at every stage of the medication use process. This quiz for PharmD students will test your knowledge of the principles, components, benefits, and challenges of designing and using effective CDS in pharmacy practice.
1. Clinical Decision Support (CDS) is best defined as a process that:
- Replaces the need for a clinician’s professional judgment.
- Provides clinicians with intelligently filtered, patient-specific information to enhance health and healthcare.
- Is used only for billing and administrative purposes.
- Manages the pharmacy’s drug inventory.
Answer: Provides clinicians with intelligently filtered, patient-specific information to enhance health and healthcare.
2. An alert that appears in the EHR when a physician prescribes a medication to which the patient has a known allergy is a classic example of:
- A medication error.
- A system malfunction.
- Clinical Decision Support.
- An e-prescribing feature.
Answer: Clinical Decision Support.
3. The “five rights” of CDS state that to be effective, CDS should deliver the right information, to the right person, in the right format, through the right channel, and at the:
- Beginning of the month.
- Right time in the clinical workflow.
- End of the provider’s shift.
- Patient’s home.
Answer: Right time in the clinical workflow.
4. A major goal of implementing CDS in the medication use process is to:
- Increase the number of steps it takes to prescribe a medication.
- Reduce medication errors and prevent adverse drug events.
- Eliminate the need for pharmacists to verify orders.
- Ensure only the most expensive drugs are used.
Answer: Reduce medication errors and prevent adverse drug events.
5. “Alert fatigue” is a significant challenge for CDS effectiveness. It describes a situation where:
- The CDS system slows down the entire EHR.
- Clinicians are exposed to too many alerts, leading them to ignore or override them.
- Patients become tired of receiving notifications on their portal.
- The IT department is tired of building new alerts.
Answer: Clinicians are exposed to too many alerts, leading them to ignore or override them.
6. A CDS system relies on three main components: the knowledge base, the inference engine, and the:
- User interface.
- Billing module.
- Communication mechanism to the patient.
- Hardware server.
Answer: Communication mechanism to the patient.
7. In a CDS system, the “inference engine” is the component that:
- Stores all the clinical rules and evidence.
- Presents the alert to the end-user.
- Connects the rules in the knowledge base with the patient’s specific data to generate an alert.
- Manages the system’s security.
Answer: Connects the rules in the knowledge base with the patient’s specific data to generate an alert.
8. For a CDS alert for a drug-drug interaction to work, the system’s drug vocabulary must be able to recognize that “atorvastatin” and “Lipitor®” are the same clinical drug. This is a function of:
- A diagnostic code set like ICD-10.
- A data standard like RxNorm.
- A lab terminology like LOINC.
- The hospital’s billing system.
Answer: A data standard like RxNorm.
9. A “hard stop” alert is a type of CDS that:
- Can be easily bypassed by the clinician.
- Provides information but does not interrupt the workflow.
- Prevents a clinician from proceeding with an order until a corrective action is taken or a reason is provided.
- Is sent to the pharmacist after the order has been processed.
Answer: Prevents a clinician from proceeding with an order until a corrective action is taken or a reason is provided.
10. An example of a “passive” CDS tool would be:
- A pop-up alert that must be acknowledged.
- An order set for community-acquired pneumonia.
- A dashboard displaying patient lab values over time.
- Both B and C.
Answer: Both B and C.
11. The use of standardized order sets within a CPOE system is a form of CDS that can:
- Increase unwanted variation in care.
- Promote evidence-based practice and reduce prescribing errors.
- Make the ordering process less efficient.
- Ensure all patients receive the same dose regardless of their individual characteristics.
Answer: Promote evidence-based practice and reduce prescribing errors.
12. A pharmacist helps to build a CDS rule based on a new guideline from the Clinical Pharmacogenetics Implementation Consortium (CPIC). This is an example of:
- Translating clinical evidence into an actionable informatics tool.
- A task outside the scope of a pharmacist’s role.
- A basic dispensing function.
- A marketing activity.
Answer: Translating clinical evidence into an actionable informatics tool.
13. A CDS alert that fires when a clinician tries to prescribe a high-dose NSAID to a patient with an ICD-10 code for “Stage 4 Chronic Kidney Disease” is linking which two types of standardized data?
- Medication data and lab data.
- Medication data and diagnostic data.
- Lab data and demographic data.
- Diagnostic data and procedural data.
Answer: Medication data and diagnostic data.
14. A key challenge in maintaining an effective CDS system is:
- The fact that medical knowledge is static.
- Keeping the knowledge base up-to-date with the latest clinical evidence and guidelines.
- The lack of new drugs being approved.
- The simplicity of all clinical rules.
Answer: Keeping the knowledge base up-to-date with the latest clinical evidence and guidelines.
15. A well-designed CDS alert should not only identify a problem but also:
- Suggest a clinically appropriate solution or alternative.
- Require the clinician to call the IT department.
- Provide a link to a social media site.
- Automatically change the order without clinician input.
Answer: Suggest a clinically appropriate solution or alternative.
16. A pharmacist’s expertise is crucial in the development of medication-related CDS because of their deep knowledge of:
- Computer programming.
- Pharmacology, therapeutics, and the medication use process.
- Hospital billing codes.
- Hardware maintenance.
Answer: Pharmacology, therapeutics, and the medication use process.
17. The use of a “Dashboard Presentation” to show a hospital’s adherence to a specific quality measure (e.g., VTE prophylaxis rates) is a form of CDS for:
- Individual patient care.
- Population health and quality improvement.
- Patient education.
- Billing audits.
Answer: Population health and quality improvement.
18. A “pre-test” CDS alert for pharmacogenomics would fire when a clinician:
- Reviews a patient’s genetic test result.
- Orders a drug for which a PGx test is recommended but has not been done.
- Documents a family history of a genetic disease.
- Enters a new allergy.
Answer: Orders a drug for which a PGx test is recommended but has not been done.
19. A “post-test” CDS alert for pharmacogenomics would fire when a clinician:
- Orders a drug for a patient with a known genetic variant that affects that drug’s safety or efficacy.
- Decides to order a genetic test.
- Admits a new patient to the hospital.
- Dispenses a medication from the pharmacy.
Answer: Orders a drug for a patient with a known genetic variant that affects that drug’s safety or efficacy.
20. To reduce alert fatigue, informatics teams can practice “alert tiering,” which involves:
- Making all alerts interruptive hard stops.
- Customizing the level of alert (e.g., passive vs. interruptive) based on the clinical severity of the potential event.
- Turning off all alerts for experienced providers.
- Showing alerts to pharmacists but not to physicians.
Answer: Customizing the level of alert (e.g., passive vs. interruptive) based on the clinical severity of the potential event.
21. A “smart pump” library with hard and soft dosing limits is a form of CDS implemented at which stage of the medication use process?
- Prescribing
- Transcribing
- Dispensing
- Administration
Answer: Administration
22. An EHR’s ability to provide a dose recommendation for a renally-cleared drug based on the patient’s latest eGFR is a sophisticated form of:
- Clinical Decision Support.
- A basic drug information lookup.
- A medication administration record.
- An inventory management function.
Answer: Clinical Decision Support.
23. The leadership skill of “change management” is essential when implementing a new CDS feature because:
- It may alter clinical workflows and requires buy-in from the end-users.
- The feature will be perfect from the start.
- All clinicians enjoy having their workflow changed.
- It is a purely technical implementation.
Answer: It may alter clinical workflows and requires buy-in from the end-users.
24. The data that powers CDS must be:
- Unstructured and in free-text format.
- Entered into the EHR only after the patient is discharged.
- Accurate, up-to-date, and in a structured, computable format.
- Kept in a separate system from the main EHR.
Answer: Accurate, up-to-date, and in a structured, computable format.
25. A key ethical consideration when designing CDS is to:
- Ensure the algorithms do not introduce or perpetuate bias that could worsen health disparities.
- Build alerts that promote the use of the most expensive medications.
- Share patient data with marketing companies.
- Make the alerts as difficult to understand as possible.
Answer: Ensure the algorithms do not introduce or perpetuate bias that could worsen health disparities.
26. The future of CDS will likely involve more use of:
- Paper-based lookup charts.
- Artificial intelligence and machine learning to provide more nuanced and predictive guidance.
- Fewer data standards.
- A reduction in the amount of data collected.
Answer: Artificial intelligence and machine learning to provide more nuanced and predictive guidance.
27. A pharmacist who helps govern the CDS system by reviewing and approving new alert requests is playing a role in:
- Informatics leadership and governance.
- Basic dispensing.
- Sterile compounding.
- Patient counseling only.
Answer: Informatics leadership and governance.
28. Why is it important to monitor the performance of a CDS alert after it is implemented?
- To measure its impact on clinical decisions (e.g., override rates).
- To identify any unintended consequences.
- To ensure it is still based on current evidence.
- All of the above.
Answer: All of the above.
29. CDS is a key tool for “forging ahead” in pharmacy because it:
- Allows for the practical, widespread application of new knowledge, like pharmacogenomics, into routine patient care.
- Helps maintain traditional, dispensing-focused practice models.
- Is not related to advancing the practice of pharmacy.
- Makes the pharmacist’s job more difficult.
Answer: Allows for the practical, widespread application of new knowledge, like pharmacogenomics, into routine patient care.
30. The ultimate measure of success for any CDS implementation is its ability to:
- Fire a large number of alerts.
- Be the most expensive system on the market.
- Improve patient outcomes and safety.
- Be popular with the hospital’s IT department.
Answer: Improve patient outcomes and safety.
31. Which of the following is NOT a form of CDS?
- A drug-allergy alert.
- An evidence-based order set.
- A free-text note in the EHR detailing a patient’s preference for a pharmacy.
- A duplicate therapy alert.
Answer: A free-text note in the EHR detailing a patient’s preference for a pharmacy.
32. A CDS rule that suggests VTE prophylaxis for an admitted patient with a high Caprini score is an example of:
- A tool to promote preventive care and adherence to guidelines.
- A drug interaction alert.
- An allergy alert.
- A therapeutic duplication alert.
Answer: A tool to promote preventive care and adherence to guidelines.
33. The “user interface” of a CDS alert refers to:
- The underlying clinical logic.
- How the alert is presented to the clinician on the screen.
- The data that triggered the alert.
- The security protocol for the alert.
Answer: How the alert is presented to the clinician on the screen.
34. A key skill for a pharmacist working in informatics is the ability to:
- Translate a clinical need into a logical rule that can be programmed into a CDS system.
- Repair computer hardware.
- Write prescriptions.
- Manage a retail pharmacy.
Answer: Translate a clinical need into a logical rule that can be programmed into a CDS system.
35. A “knowledge base” is a critical component of a CDS system that contains:
- A list of all patients in the hospital.
- The library of clinical rules, evidence, and associations that the system uses.
- The user’s login credentials.
- The schedule for system downtime.
Answer: The library of clinical rules, evidence, and associations that the system uses.
36. A significant barrier to implementing effective CDS in an ambulatory care pharmacy is often:
- A lack of access to the prescriber’s comprehensive EHR data.
- The fact that ambulatory patients are never on complex medication regimens.
- An overabundance of time for clinical interventions.
- The low number of prescriptions dispensed.
Answer: A lack of access to the prescriber’s comprehensive EHR data.
37. The use of an EHR in a skills lab, such as EHR Go, helps students understand CDS by:
- Allowing them to experience how alerts function in a simulated clinical workflow.
- Teaching them how to build their own CDS rules.
- Showing them how to override every alert.
- Focusing only on the dispensing process.
Answer: Allowing them to experience how alerts function in a simulated clinical workflow.
38. The data standard that helps a CDS system understand that “myocardial infarction” and “heart attack” are related concepts is:
- RxNorm
- LOINC
- SNOMED CT
- NDC
Answer: SNOMED CT
39. A pharmacist’s role in the “monitoring” stage of the medication use process is supported by CDS that:
- Can alert them to a new lab value that is critically out of range for a patient on a high-risk medication.
- Automatically refills a prescription.
- Reminds the patient about their next appointment.
- Calculates the cost of the medication.
Answer: Can alert them to a new lab value that is critically out of range for a patient on a high-risk medication.
40. A well-designed CDS system should feel like a ________ to a clinician.
- A hindrance and a roadblock.
- A helpful, expert consultant.
- A micro-manager.
- An unnecessary expense.
Answer: A helpful, expert consultant.
41. The development of CDS has been a key driver of which major healthcare initiative?
- The move towards evidence-based medicine.
- The return to paper charting.
- The reduction of pharmacy operating hours.
- The expansion of hospital cafeterias.
Answer: The move towards evidence-based medicine.
42. Which leadership skill is most important when trying to get clinician buy-in for a new CDS feature?
- The ability to communicate the “why” – how the feature will improve patient safety or efficiency.
- An authoritarian approach that forces adoption.
- A focus only on the technical details of the feature.
- A promise that the feature will never fire an alert.
Answer: The ability to communicate the “why” – how the feature will improve patient safety or efficiency.
43. A major reason for a high “override rate” for a CDS alert is that:
- The alert is firing appropriately for a clinically significant issue.
- The alert is not clinically relevant or is firing in situations where it is not helpful.
- The clinicians are not properly trained on the EHR.
- The IT department has not done their job.
Answer: The alert is not clinically relevant or is firing in situations where it is not helpful.
44. CDS is a key enabler of “population health management” because it allows a health system to:
- Manage individual patient prescriptions one at a time.
- Systematically apply evidence-based care standards to large groups of patients.
- Focus only on the healthiest patients.
- Bill for services more easily.
Answer: Systematically apply evidence-based care standards to large groups of patients.
45. For a CDS system to be trusted by users, its recommendations must be:
- Based on the personal opinions of the informatics team.
- Based on strong clinical evidence.
- Designed to increase revenue.
- Kept secret from the clinicians.
Answer: Based on strong clinical evidence.
46. A “bug” in a CDS rule that causes it to fire incorrectly for every patient is a serious safety concern that requires:
- The pharmacist to manually check every alert.
- The rule to be immediately disabled and investigated by the informatics team.
- The hospital to switch to a new EHR vendor.
- The clinicians to learn how to ignore the alert.
Answer: The rule to be immediately disabled and investigated by the informatics team.
47. The future of CDS involves moving from simple, rule-based alerts to more sophisticated systems that can:
- Predict which patients are at highest risk for an adverse event.
- Analyze unstructured free-text notes.
- Personalize recommendations based on a patient’s complete genomic and clinical profile.
- All of the above.
Answer: All of the above.
48. Why must a pharmacist be a “lifelong learner” to be effective in the world of CDS?
- Because the clinical evidence that powers CDS is constantly changing.
- Because the technology is static.
- To fulfill a one-time requirement for licensure.
- To be able to talk to the IT department.
Answer: Because the clinical evidence that powers CDS is constantly changing.
49. An example of a workflow where CDS is poorly implemented would be:
- An alert that fires at the time of prescribing.
- An alert for a dispensing issue that is shown to the physician instead of the pharmacist.
- An order set that is available when a provider is admitting a new patient.
- A reference link that is available within a patient’s chart.
Answer: An alert for a dispensing issue that is shown to the physician instead of the pharmacist.
50. Ultimately, the effective use of CDS in pharmacy practice is a key strategy for achieving the goals of:
- The Quadruple Aim (better outcomes, improved patient experience, lower costs, and improved clinician experience).
- Increasing pharmacy profits only.
- Making the medication use process more complicated.
- Replacing the need for clinical judgment.
Answer: The Quadruple Aim (better outcomes, improved patient experience, lower costs, and improved clinician experience).
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com