CDS Hooks have gained significant attention as a promising technology for integrating clinical decision support (CDS) directly into Electronic Health Records (EHRs).
Unfortunately, as of today, not all major EHR systems have rolled out full production support for CDS Hooks.
Despite this, there are alternative technologies already available that allow developers to embed custom, interactive functionality into EHRs and achieve similar goals. In this blog post, we’ll explore some of these technologies.
1. Cerner Command Language (CCL)
Cerner Command Language (CCL) is a powerful tool available for developers looking to integrate custom functionality into Oracle Health (formerly Cerner). CCL allows you to write custom reports, interact with Oracle Health Millennium databases, and even embed real-time functionality into clinician workflows.
How CCL Works
CCL is a SQL-based scripting language that enables developers to:
- Create custom data queries.
- Build interactive reports.
- Embed executable logic that can trigger specific workflows.
Using CCL, developers can create user-defined functions that interact directly with clinical data stored in Oracle Health EHR and display actionable insights in real-time. These functions can include custom alerts, decision support prompts, or other actionable insights relevant to patient care.
Embedding Custom Functionality with CCL
Developers can embed CCL-based reports or functionality in Oracle Health PowerChart, the clinician-facing application. By creating Discern Alerts or custom MPages, you can trigger notifications or display additional data during key points in the clinician’s workflow. While not as standardized as CDS Hooks, CCL allows for robust real-time interactions, providing clinicians with clinical insights and suggested actions based on current patient data.
Here is a sample video that describes how to implement and use a Discern Alert to provide custom clinical decision support functionality, while this video runs through how to set up a custom MPage workflow.
Does Oracle Health / Cerner Support CDS Hooks?
As of early 2025, Oracle Health’s CDS Hooks implementation is not generally available.
2. MEDITECH Integration Tools
MEDITECH has long been a player in the EHR space, but as of this writing, it has only limited support for CDS Hooks. Luckily, developers can still embed custom functionality into clinical workflows using MEDITECH’s NPR (Non-Procedural Representation) Report Writer and Customer Defined Screens.
NPR Report Writer
MEDITECH’s NPR is a reporting tool that allows developers to create custom reports and workflows. NPR can interact with the Meditech database to pull real-time clinical data and display actionable insights.
While it is traditionally used for reporting purposes, it can also be adapted to provide decision support by delivering recommendations or reminders based on current patient data.
Customer Defined Screens (CDS)
MEDITECH provides the ability for customers to define their own groups or even screens of questions in order to capture information which isn’t represented in the off-the-shelf setup of the various MEDITECH screens.
Known as Customer Defined Screens (CDS), these questions may have defined data types for responses, such as free text areas, choices, or lookups to other dictionaries (“settings” screens). (Note that “CDS” in this context is different from CDS Hooks.)
After configuring these CDS queries and screens, customers can update their clinical and administrative screens to include them. Generally, whatever program needs to be extended to include customer data can have its own screen to define what CDS values should be used.
As an example, this training video goes through a few CDS setup steps for the CWS (Community Wide Scheduling) program in MEDITECH 5.6. The video shows how the CDS data may be specified in CWS dictionaries, and how it gets shown in the routines.
3. Epic Integration Tools
Although Epic already supports CDS Hooks in production, developers may also access a range of powerful alternatives, including Epic SmartForms, Epic’s APIs, and BestPractice Advisories (BPAs).
SmartForms
Epic’s SmartForms allow for the creation of custom data entry forms that integrate directly into clinical workflows. SmartForms are customizable, interactive, and capable of triggering specific actions or guiding the clinician through decision support pathways based on entered data.
By configuring logic within SmartForms, developers can create decision trees that provide clinical recommendations, suggest orders, or facilitate data capture in a structured and meaningful way.
These forms are highly integrated with Epic’s backend, meaning they can leverage real-time clinical data to provide context-sensitive guidance.
BestPractice Advisories (BPAs)
BPAs are another tool in Epic’s ecosystem that provides decision support within the clinician’s workflow. BPAs are essentially configurable alerts or notifications that pop up when certain criteria are met. They can be configured to trigger based on patient data, clinical guidelines, or specific workflows, providing actionable recommendations or prompts for the clinician.
For developers, BPAs can be used to implement custom decision support logic and embed custom functionality. While they’re not as flexible as CDS Hooks, BPAs allow real-time decision support based on clinical data and help streamline patient care.
Epic APIs
Epic offers a suite of APIs that enable external systems to interact with the EHR. Developers can use these APIs to push or pull data from Epic, embed external decision support logic, or integrate third-party applications into the workflow.
With Epic’s API capabilities, developers can achieve similar goals to CDS Hooks by integrating external clinical decision tools or services into the EHR workflow.
Achieving CDS Hooks-Like Functionality Today
While CDS Hooks holds promise for the future, developers working with leading EHRs today don’t have to wait for its full implementation to achieve similar results. Each of these EHRs offers powerful tools to integrate custom, interactive functionality that can provide clinical decision support, guide workflows, and improve patient outcomes.
- Oracle Health: Use CCL for custom queries, reports, and real-time alerts with Discern Alerts and MPages.
- MEDITECH: Leverage NPR and Customer Defined Screens for creating custom forms, reports, and custom data gathering workflows integrated with the EHR.
- Epic: Implement custom decision support with SmartForms, BPAs, and APIs to embed real-time, actionable insights into clinical workflows.
While these tools may not offer the universal standardization of CDS Hooks, they enable developers to embed crucial decision support and custom features into EHRs today.
Understanding and leveraging these technologies will allow you to bring real-time, interactive decision support to healthcare organizations, helping clinicians provide better care and improving overall patient outcomes.
Additionally, you can always use SMART on FHIR to integrate third party applications directly into the above EHRs.
By exploring and implementing these available options, developers can take steps today toward embedding interactive, custom functionality in EHR systems, while CDS Hooks continues its journey to full production adoption.
See what’s already possible in today’s EHRs. Reach out to the medtech experts at SiteRocket Labs to scope your build.
