Email Updates
Override reasons are provided by clinicians, patients, or caregivers when declining PC CDS recommendations, but these reasons often vary widely in terminology and specificity across systems. This inconsistency creates challenges in analyzing override data, which can help to improve PC CDS functionality, and can increase cognitive burden on users. Building on previous CDSiC efforts that developed a taxonomy of override reasons for PC CDS recommendations, this report presents options for user-friendly interface terms and strategies to advance the implementation of the taxonomy. this report presents example override reasons to improve consistency across PC CDS and explores strategies to advance the implementation of the taxonomy.
About the Report
This report features example user override reasons, mapped to the taxonomy subdomains, that can be used by health systems implementing the override taxonomy. It also details potential strategies for implementing the override taxonomy in PC CDS systems. The strategies cover standardizing the override taxonomy’s subdomains in a code system, as well as integrating the taxonomy into existing standards for PC CDS, such as HL7 CDS Hooks or Arden Syntax.
The report highlights five directions for future efforts to improve the override taxonomy and facilitate its implementation:
- Additional qualitative research to optimize usability and contextual relevance.
- Connectathons to help identify gaps and spread awareness of the taxonomy and example user override reasons within the standards community.
- Pilot testing and refinement in multiple health systems for real-world testing to enable feedback, data collection, and documentation of lessons learned.
- Integration into the United States Core Data for Interoperability Plus (USCDI+) (e.g., Quality Domain) to support broader adoption.
- Harmonization with clinical quality measure override concepts to support alignment in data collection and reporting, where appropriate.
How To Use This Report
PC CDS developers, researchers, and standards organizations can use this report’s findings to advance standardized approaches to override terminology in PC CDS, thus enhancing both the structured capture of override data for PC CDS analysis as well as consistent presentation of override reasons to PC CDS recipients.
Suggested Citation: Boxwala AA, Correa KH, Richesson RL, Leaphart D, Ahmed A, Desai PJ, the CDSiC Standards and Regulatory Frameworks Workgroup, and Dullabh PM. CDS Standards and Regulatory Frameworks Workgroup: Approaches to Standardizing Override Reasons for Patient-Centered Clinical Decision Support. Prepared under Contract No. 75Q80120D00018. AHRQ Publication No. 25-0073. Agency for Healthcare Research and Quality; June 2025.
