Screen pop-ups that alert, notify and suggest are a big part of clinical decision support (CDS).\u00a0 But they are not the only ways to provide support.\u00a0 They may not even be the best. The reason is simple. Alerts must \u201cfire,\u201d which means they need a trigger.\nSometimes those triggers are events that pose a threat to the welfare of the patient, put reimbursement at risk, or slow workflow.\u00a0 Triggers, therefore, mean the risk has appeared.\nProactive tools put the clinician ahead of the game.\u00a0 They can provide a \u201cheads up\u201d on something a patient needs like a test, a treatment, or a change in lifestyle. They turn clinical guidelines into condition-specific orders or recommendations for the 60-something patient who has a family history of colon cancer but no record of colonoscopy.\nArmed with these facts, the physician convinces the patient \u2013 let\u2019s say, a football coach with the personality of his high-school team\u2019s mascot \u2013 to get a colonoscopy. \u00a0The test spots a tumor, which turns out to be cancer; for which the patient gets treatment; after which he lives to celebrate his next birthday and more.\u00a0\nHere the CDS tool was built around an algorithm that mined the patient\u2019s history. It uncovered risks, then looked for results from clinical tests that should have been performed.\u00a0 When none were found, the CDS notified the physician of the specific test that should be done.\u00a0 If results had been found, the CDS would have provided them to the physician.\u00a0\u00a0\u00a0 \u00a0\nTo be effective, CDS requires a kit comprised of several tools, each for a specific task. One might call-up a template that documents a patient\u2019s condition.\u00a0 Another might provide references helpful in the interpretation of an electronic health record (EHR).\nWhat they all have in common is that they look for ways to make the physician more effective and more efficient \u2013 preventively, diagnostically, or therapeutically.\nIt\u2019s easy to recognize a good CDS tool, using little more than the axiom \u201cyou\u2019ll know it when you see it.\u201d Determining ahead of time, however, whether a CDS tool will help \u2013 and figuring which tool will do the job \u2013 takes a bit more analysis.\u00a0 The evaluation comes down to assessing the \u201cfive rights\u201d of CDS:\n1. The right information\n2. To the right person\n3. In the right intervention format\n4. Through the right channel\n5. At the right time in the workflow\nRight information\u2026evidence-based, derived from a set of recognized guidelines or based on a national performance measure \u2013 detailed enough for the end user to act upon, but not so detailed as to overload or cause the user to disregard it.\nRight person\u2026nurse, physician, physical therapist, significant other \u2013 whoever needs the information in order to act appropriately, excluding anyone who cannot take action.\nRight way to intervene\u2026alerts, order sets, protocols, patient monitoring systems, and info buttons \u2013 whatever is best suited to solve or address the problem or issue.\u00a0\nRight channel\u2026EHR, personal health record, computerized physician order entry, an app running on a smartphone, even a paper-based flowsheet, form or label.\u00a0 Choosing the right channel depends on the person and circumstances under which the information is to be delivered. An EHR may be the best choice, when sending information to a physician in a networked office; but a smartphone app might be better suited, if the physician cannot access the network.)\nRight timing\u2026presenting information when it will do the most good. \u00a0Recognizing early in the prescription process that a patient is taking aspirin before sending the script for a blood thinner to the pharmacy is a good thing. \u00a0\nTogether the five rights provide a \u201cbest practice framework.\u201d The common denominator of CDS is the improvement of patient care. Choosing the right tool is the goal.