Project Overview


This project is a part of the Veterans Health Administration (VHA) Greenfield Incubation initiative. Its official name is “Enhanced Clinical Decision Support for CPRS” (initiative number 209).

Project submitted by Dr. Clayton Curtis (Boston VAMC and CHIO). Development work was contracted to HP Enterprise Services, with subcontracts to Medexter and Medical Objects.

The Purpose (Mission)

Improvement of patient care through greater and more effective clinical decision support at the point of care.

Benefits to VA/VHA:

This proposal would be a first of its kind effort to enable VA’s Electronic Health Record (EHR) to use a standards-based Clinical Decision Support (CDS) framework to support complex decision support needs of clinicians at the point of care.
In 3 meetings in 2008, senior clinicians from VHA met to develop a set of guiding principles and desired characteristics for the EHR. In the summary report (available on the VHA intranet), the term decision support appears multiple times.
VA is better positioned than almost any other health care organization to take advantage of CDS. VA goals for quality, safety, and efficiency are tightly linked to decisions clinicians make while sitting at computers.
Beyond the direct impact on quality, safety, and efficiency, this proof of concept sets the stage for more sophisticated use of CDS in the future.


The over-all objective of the project is to successfully link a standards-based decision support framework to VHA’s CPRS/VistA, with replication of the current clinical reminder capability and generation of a patient “report card” as initial applications demonstrating the technical innovation. Because the framework will include rules with both “logic” and “action” components (unlike the current clinical reminder system), it will also be possible to demonstrate other forms of integration with CPRS, such as recommending additions to the problem list based on data, chaining screening and evaluation reminders, etc. In addition, it will be possible to demonstrate uses of the framework for non-traditional applications, such as a patient report card. The major technical components of this project are the introduction of the ARDEN standard for encoding clinical logic in Medical Logic Modules (MLM) and development of an interface to Medical Domain Web Services (MDWS) for data services: the virtual Medical Record (vMR) interface to be accessed by HL7 GELLO interface.

For more information on the Project please visit the following link:

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