There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human computer interface disseminate best practices in CDS design, development and implementation; summarize patient-level information; prioritize and filter recommendations to the user create an architecture for sharing executable CDS modules and services combine recommendations for patients with co-morbidities prioritize CDS content development and implementation create internet-accessible clinical decision support repositories use free text information to drive clinical decision support mine large clinical databases to create new CDS.
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