To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support

Abstract

Background Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details.

Objective Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or “artifacts.”

Methods In 2016, the Agency for Healthcare Research and Quality (AHRQ) launched CDS Connect as a public, web-based platform for authoring and sharing CDS knowledge artifacts. Researchers evaluated early use and impact of the platform by collecting user experiences of AHRQ-sponsored and community-led dissemination efforts and through quantitative/qualitative analysis of site metrics. Efforts are ongoing to quantify efficiencies gained by healthcare systems that leverage shared, interoperable CDS artifacts rather than developing similar CDS de novo and in isolation.

Results Federal agencies, academic institutions, and others have contributed over 50 entries to CDS Connect for sharing and dissemination. Analysis indicates shareable CDS resources reduce team sizes and the number of tasks and time required to design, develop, and deploy CDS. However, the platform needs further optimization to address sociotechnical challenges. Benefits of sharing include inspiring others to undertake similar CDS projects, identifying external collaborators, and improving CDS artifacts as a result of feedback. Organizations are adapting content available through the platform for continued research, innovation, and local implementations.

Conclusion CDS Connect has provided a functional platform where CDS developers are actively sharing their work. CDS sharing may lead to improved implementation efficiency through numerous pathways, and further research is ongoing to quantify efficiencies gained.

Keywords

clinical decision support - interoperability - computable guidelines - knowledge management - shared repository

Protection of Human and Animal Subjects

The work described was performed in compliance with US Code of Federal Regulations 45 CFR 46 and was reviewed by Institutional Review Boards at MITRE and MedStar Health.

• References

• 1 Jacob V, Thota AB, Chattopadhyay SK. , et al. Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review. J Am Med Inform Assoc 2017; 24 (03) 669-676
• 2 Tcheng JE, Bakken S, Bates DW. , et al., Eds. Optimizing strategies for clinical decision support. Washington, D.C.: National Academy of Medicine; 2017
• 3 Masterson Creber RM, Dayan PS, Kuppermann N. , et al; Pediatric Emergency Care Applied Research Network (PECARN) and the Clinical Research on Emergency Services and Treatments (CREST) Network. Applying the RE-AIM framework for the evaluation of a clinical decision support tool for pediatric head trauma: a mixed-methods study. Appl Clin Inform 2018; 9 (03) 693-703
• 4 Johnston D, Pan E, Walker J, Bates DW, Middleton B. The value of computerized provider order entry in ambulatory settings. Boston: Center for Information Technology Leadership; Available at: https://www.researchgate.net/publication/7649275_The_value_of_CPOE_in_ambulatory_settings . Accessed January 8, 2020
• 5 Osheroff JA. , Ed. Improving medication use and outcomes with clinical decision support: a step-by-step guide. 1st ed. Chicago: HIMSS Publishing; 2009
• 6 Patient-Centered Clinical Decision Support Learning Network. Analytic framework for action. Available at: https://pccds-ln.org/analytic-framework . Accessed July 8, 2019
• 7 Agency for Healthcare Research and Quality. Patient-centered outcomes research clinical decision support: accelerating evidence into practice through CDS. Available at: https://cds.ahrq.gov/ . Accessed July 8, 2019
• 8 U.S. National Library of Medicine. Welcome to Medical Subject Headings. Available at: https://www.nlm.nih.gov/mesh/meshhome.html . Accessed July 8, 2019
• 9 Boxwala AA, Rocha BH, Maviglia S. , et al. A multi-layered framework for disseminating knowledge for computer-based decision support. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i132-i139
• 10 Agency for Healthcare Research and Quality. Clinical Decision Support Repositories. Available at: https://github.com/AHRQ-CDS?tab=repositories . Accessed July 8, 2019
• 11 Bates DW, Kuperman GJ, Wang S. , et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003; 10 (06) 523-530
• 12 Orenstein EW, Yun K, Warden C. , et al. Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules. J Am Med Inform Assoc 2019; 26 (12) 1515-1524
• 13 Agency for Healthcare Research and Quality. Health Information Technology: Clinical Decision Support Consortium (Massachusetts). Available at: https://healthit.ahrq.gov/ahrq-funded-projects/clinical-decision-support-consortium . Accessed July 8, 2019
• 14 Middleton B. The clinical decision support consortium. Stud Health Technol Inform 2009; 150: 26-30
• 15 Agency for Healthcare Research and Quality. Health Information Technology: Guidelines Into Decision Support (Connecticut). Available at: https://healthit.ahrq.gov/ahrq-funded-projects/guidelines-decision-support-glides#h=glides . Accessed July 8, 2019
• 16 Health Level 7. Fast Healthcare Interoperability Resources (FHIR) Overview. Available at: https://www.hl7.org/fhir/overview.html . Accessed July 8, 2019
• 17 Centers for Medicare & Medicaid Services. Electronic Clinical Quality Improvement Resource Center: CQL – Clinical Quality Language. Available at: https://ecqi.healthit.gov/cql-clinical-quality-language#quicktabs-tabs_cql1 . Accessed July 8, 2019
• 18 Health Level 7. CDS Hooks. Available at: https://cds-hooks.hl7.org/ . Accessed July 8, 2019
• 19 Boston Children's Hospital Computational Health Informatics Program and Harvard Medical School Department of Biomedical Informatics. SMART: An App Platform for Healthcare. Available at: https://smarthealthit.org/ . Accessed July 8, 2019
• 20 Centers for Disease Control and Prevention. Deputy Director for public health science and surveillance: adapting clinical guidelines for the digital age. Available at: https://www.cdc.gov/ddphss/clinical-guidelines/index.html . Accessed July 8, 2019
• 21 Middleton B, Platt JE, Richardson J, Blumenfeld BH. Recommendations for building and maintaining trust in clinical decision support knowledge artifacts. Research Triangle Park, NC: Patient-Centered Clinical Decision Support Learning Network; 2018