You are developing a system to analyze clinician handling of computerized decision support (CDS) recommendations. CDS systems provide testing, treatment, and dosing recommendations to clinicians based on data available in the EHR (Electronic Health Record) while the provider is interacting with the EHR on a given patient via a pop-up alert box. Clinicians are able to accept the CDS recommendation, in which case the order is entered in the EHR automatically, or they can decline the recommendation being given a choice of reasons for declining as well as the option of entering full text explanation of why they declined the recommendation. The analysis system that you are developing will allow determining the rates that CDS recommendations are accepted and declined, as well as providing insight into the reasons for declining the recommendations. In this manner the CDS rules that generate the recommendations can be selected and modified to best support the clinicians and high-quality health care delivery. Data must be extracted from the EHR and then processed to compute the frequency rates of each recommendation, as well as the rates of acceptance, decline, and reasons for decline of each individual CDS rule and its recommendation. Your analysis system will be used to create visualizations of institutional and group practice CDS usage, including bar charts as well as graphing percentages over time. There are multiple CDS measures to be tracked, and each measure its own counts and frequencies. Assume that measures are tracked at weekly intervals. Reports should be generated weekly and send to the CDS management team as well as individual department heads via email.

1. Draw a context diagram for this system. Consider the other systems in a large hospital that may be involved in creating the data needed for this system, or reporting the results of this system to users. These other systems may or may not have direct electronic connections to the clinical quality measure system.

2. What high-level system architecture design is most appropriate for this system? Explain your reasoning.