The need for effective and efficient clinical decision support (CDS) embedded in electronic health record (EHR) processes is growing. Using choice architecture design strategies may increase effectiveness of CDS solutions. The authors describe implementation of an opioid risk alert and subsequent revisions of that alert to increase effectiveness and reduce alert volumes. The first version of the alert used an opt-in choice architecture when recommending naloxone and the second version used an active choice design. The percentage of opioid prescriptions ordered with naloxone prescribed within the last 12 months increased significantly after implementation of the first version of the alert and then further increased significantly after implementation of the second version. Alert volumes decreased over the same timeframe. An education campaign was also implemented during the timeframe studied and likely also contributed to the naloxone outcomes seen.
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