Appl Clin Inform 2019; 10(05): 810-819
DOI: 10.1055/s-0039-1697905
State of the Art/Best Practice Paper
Georg Thieme Verlag KG Stuttgart · New York

Towards a Maturity Model for Clinical Decision Support Operations

Evan W. Orenstein
1  Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
2  Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Naveen Muthu
3  Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4  Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Asli O. Weitkamp
5  Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Daria F. Ferro
3  Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4  Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Mike D. Zeidlhack
6  Phrase Health Inc., Philadelphia, Pennsylvania, United States
,
Jason Slagle
5  Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Eric Shelov
3  Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4  Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Marc C. Tobias
6  Phrase Health Inc., Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

04 May 2019

14 August 2019

Publication Date:
30 October 2019 (online)

Abstract

Clinical decision support (CDS) systems delivered through the electronic health record are an important element of quality and safety initiatives within a health care system. However, managing a large CDS knowledge base can be an overwhelming task for informatics teams. Additionally, it can be difficult for these informatics teams to communicate their goals with external operational stakeholders and define concrete steps for improvement. We aimed to develop a maturity model that describes a roadmap toward organizational functions and processes that help health care systems use CDS more effectively to drive better outcomes. We developed a maturity model for CDS operations through discussions with health care leaders at 80 organizations, iterative model development by four clinical informaticists, and subsequent review with 19 health care organizations. We ceased iterations when feedback from three organizations did not result in any changes to the model. The proposed CDS maturity model includes three main “pillars”: “Content Creation,” “Analytics and Reporting,” and “Governance and Management.” Each pillar contains five levels—advancing along each pillar provides CDS teams a deeper understanding of the processes CDS systems are intended to improve. A “roof” represents the CDS functions that become attainable after advancing along each of the pillars. Organizations are not required to advance in order and can develop in one pillar separately from another. However, we hypothesize that optimal deployment of preceding levels and advancing in tandem along the pillars increase the value of organizational investment in higher levels of CDS maturity. In addition to describing the maturity model and its development, we also provide three case studies of health care organizations using the model for self-assessment and determine next steps in CDS development.

Authors' Contributions

E.W.O., N.M., A.O.W., D.F.F., M.D.Z., J.S., E.S., and M.C.T. wrote the manuscript. N.M., M.D.Z., and M.C.T. performed primary data collection. E.W.O., N.M., D.F.F., M.D.Z., and M.C.T. analyzed the data and developed the proposed CDS maturity model.


Protection of Human and Animal Subjects

No human subjects were involved in this project.