Clinical decision support (CDS) systems are a long way from mainstream.\u00a0 But they\u2019re coming fast, and health IT has to get ready.\u00a0\nOn January 1, 2017, healthcare providers who order advanced imaging exams have to begin using CDS when placing their orders for Medicare patients. It\u2019s the law, as written in the Protecting Access to Medicare Act of 2014.\nThe teeth behind it are more dachshund than pit bull.\u00a0 But if you\u2019ve ever turned your back on a dachshund, you know it can be a mistake.\nStarting in 2017, the Centers for Medicare and Medicaid will begin tracking providers.\u00a0 Those who don\u2019t follow the guidelines for using CDS when ordering advanced imaging for Medicare patients will be identified over the next three years \u2013 based on two years of performance \u2013 and be ordered to obtain \u201cprior authorization for applicable imaging services\u201d for an \u201cappropriate\u201d period. This time there will be a bite in the pay those providers receive \u2013 or more exactly, don\u2019t receive.\nTranslation: Unless you want the government forcing your providers to routinely preauthorize every advanced imaging exam they order for their Medicare patients, you\u2019ve got 14 months to implement a CDS.\u00a0\nLook at CDS as a way to empower your organization, to maintain its control over imaging utilization, by keeping third-party radiology benefits managers from getting their mitts on it. That\u2019s number one.\nIn the meantime there are other reasons to embrace CDS. Number two has to do with \u201cMeaningful Use\u201d and the 2009 HITECH Act, which provides financial incentives for providers to adopt electronic health record systems (EHRs).\u00a0\nStage 1 of Meaningful Use, already in force, calls for the implementation of one CDS rule \u201crelevant to specialty or high clinical priority\u201d along with the ability to track compliance with that rule. The bar rises in successive stages.\nIn stage 2, providers must implement five CDS interventions related to four or more clinical quality measures. In the third and final stage, providers could be asked to implement 15 CDS interventions related to five or more clinical quality measures, according to draft recommendations submitted by the Meaningful Use Work Group. Two or more may be required in preventive care; chronic disease management;\u00a0 appropriateness of lab and radiology orders; advanced medication-related decision support; and improving the accuracy or completeness of the problem list for one or more chronic conditions. Note the listing of radiology orders \u2013 another reason to pay attention to the medical imaging mandate contained in the Protecting Access to Medicare Act of 2014.\nA third reason to adopt CDS is the uncertain environment for reimbursement. We've seen decades of cuts in reimbursements, not raises.\u00a0 And it won\u2019t be getting better, just different.\nAs value-based medicine supplants the traditional fee-for-service model of reimbursement, payments will be linked to patient outcomes. CDS offers a chance for providers to prove to insurers that they are serious about improving the care given patients.\nStudies of CDS "indicate improvements in preventive services, appropriate care, and clinical and cost outcomes," writes Dr. Elizabeth V. Murphy of the Oregon Health & Science University in her paper, \u201cClinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success.\u201d \u00a0\nFor those in health IT who want a leg up in the transition to CDS, the government recommends five steps:\n\nIntegrate CDS with an initiative to improve quality\nAssemble a CDS implementation team\nMatch CDS to the processes and goals of the provider\nRoll out a few high-impact CDS interventions\nMeasure their effects.\n\nThe sooner health IT professionals take these steps, the better.