A preoperative decision support platform had the clinical intelligence right, but physicians still had to copy its lab and test recommendations by hand into Epic. We built a Sign_Order CDS Hook that surfaces missing labs at the exact moment physicians place orders, closing the gap between recommendation and action.
Talk to Our TeamA preoperative clinical decision support platform built by a board-certified anesthesiologist to guide lab and test ordering before surgery.
A CDS Hook integration embedding the platform's lab and test recommendations directly into Epic's physician ordering workflow.
CDS Hooks (Sign_Order trigger), Epic EHR, FHIR API.
Live in production, with a SMART on FHIR launch point planned for the next phase.
Once the CDS Hook went live, the platform's recommendations stopped depending on a physician remembering to transfer them.
Reduction in missed pre-op labs: missed labs dropped from 15% of cases to 2%.
Reduction in time spent ordering labs: physician ordering time dropped from 60 minutes a day to 10–15 minutes.
Reduction in surgery delays from missing labs: OR delays dropped from 10 a month to 3–5 a month.
Provider engagement with the CDS tool at go-live.
The platform could generate accurate, patient-specific recommendations. Getting them into Epic was left entirely to the physician.
Physicians had to manually copy recommendations out of the platform and paste them into Epic's order module for every patient, every day.
Under time pressure, physicians skipped or abbreviated the copy-paste step, leading to missed pre-op labs and delayed surgeries.
A clinical decision support tool that requires a human to manually transfer its recommendations into the EHR has not automated the decision. It has just added a step.
Built on Epic's CDS Hooks framework, with a SMART on FHIR launch point planned for the next phase.
We implemented a Sign_Order CDS Hook that triggers automatically when a physician finalizes lab and test orders in Epic. The hook fires at the moment physicians are already making ordering decisions, without a separate step or a switch to another application.
When the hook triggers, the platform runs its decision logic against what the physician has already ordered and returns only the labs and tests that are missing. Physicians get a focused, actionable prompt instead of a full re-review of orders they already got right.
A CDS Card surfaces directly inside the Epic interface, presenting the missing labs and tests the physician may have overlooked. The card reflects the specific patient's conditions, the physician's current order set, and the clinical rules the platform uses to determine what's necessary. The next phase adds a SMART on FHIR launch point so physicians can define their own lab and test rules.
Epic's sandbox environment does not support live CDS Hook triggers, so we built and validated the integration through our own simulation and validation approach. Documentation around Epic's Sign_Order trigger was incomplete and at points contradicted itself between Epic's developer portal and the CDS Hooks spec, so we treated the API's actual behavior as ground truth. Where Epic's API had limited support for certain data retrieval paths, we built targeted workarounds to keep the patient data sent to the platform's backend complete and reliable.
Talk to us about what a CDS Hook integration looks like for your platform.
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