Building a Future for Shared Clinical Decision Support

By Edwin Lomotan, MD, FAAP, an exhibitor at the HIMSS Interoperability Showcase™ at the 2018 HIMSS Global Conference & Exhibition; and Medical Officer and Chief of Clinical Informatics, Agency for Healthcare Research and Quality

Recently, the National Academy of Medicine (NAM) released Optimizing Strategies for Clinical Decision Support that recognized several decades of work to advance clinical decision support (CDS) as means to improve healthcare quality and safety. While we’ve made good progress, tremendous opportunity for CDS still exists. The NAM identified 13 Priorities for Collaborative Action, including creating a national CDS repository, developing a multi-stakeholder CDS community and investing in CDS research.

Agency for Healthcare Research and Quality Initiative

These three priorities are key aspects of a recent initiative from the Agency for Healthcare Research and Quality (AHRQ). The AHRQ initiative has bold goals: to advance evidence into practice through CDS and to make CDS more shareable, standards-based, and publicly available.

There are four components of this initiative:

  1. Patient-Centered CDS Learning Network, which is building a learning community of stakeholders to advance the concept of patient-centered CDS
  2. CDS Connect, which is building prototype infrastructure for authoring and sharing CDS
  3. Funding opportunities for research on disseminating and implementing evidence into practice through CDS
  4. Overall evaluation

CDS Connect: One Source of Shareable CDS Logic

CDS Connect, a collaborative project between AHRQ and the MITRE Corporation, is participating in this year’s value-based care demonstration at the HIMSS Interoperability Showcase™. CDS Connect plays the role of a trusted source of shareable, interoperable CDS. It is the home for the CDS logic that drives the use case demonstration and is the platform for authoring and sharing the CDS logic.

CDS Connect uses the HL7 Clinical Quality Language to express an interoperable representation of the logic, so that it’s agnostic to the electronic health record, the CDS platform, or other technology used to deliver the CDS to the intended target audience. We know that CDS can be delivered in many different ways under many different service models. It’s our hope that CDS Connect can serve as one source of shareable CDS logic from which EHR developers, CDS implementers, and healthcare organizations can draw.

But it’s not just the CDS logic that’s important. We know that for CDS to improve clinical care, it has to be properly inserted into workflow, has to be useful and usable, and most importantly, has to meet patient needs. The journey between shareable CDS logic and what actually gets displayed on a computer screen is full of twists and turns. The map is informed by local clinical committees, IT capabilities and other organizational factors. Knowing when an organization faced choices and decided to turn left instead of right is critically important for making CDS systematic and replicable. This is another reason CDS Connect exists: to help organizations know each other’s journeys when it comes to CDS implementation, so that they can choose the best path for themselves and their patients.

Patient-Centered Learning Network

Patients and families are at the center of AHRQ’s CDS initiative. It’s one reason that the Learning Network named itself the Patient-Centered CDS Learning Network and is advancing a patient-centered Analytic Framework for Action.

In the first year of CDS Connect and with the help of AllianceChicago, we developed statin therapy CDS that was implemented as a screen to be viewed by clinicians and patients simultaneously. We are enlisting the help of patient advocates to ensure that what we are building is understandable and that can help care teams and patients work together. We are also enlisting the help of many other stakeholders to gather as much comprehensive and inclusive feedback as we can. The Learning Network convenes during an annual in-person meeting and CDS Connect has a work group with representation from over 30 organizations.

Just 18 months into the initiative, we have much to learn and to do as we build on the insights of the last several decades and to respond to the NAM priorities. We are excited by the future and hope that you will join us.

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