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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(03): 566-574
DOI: 10.1055/s-0043-1769911
Research Article

Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support

Rina V. Dhopeshwarkar
1   Department of Health Sciences, NORC at the University of Chicago, Bethesda, Maryland, United States
,
Maysoun Freij
2   Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, United States
,
Melissa Callaham
1   Department of Health Sciences, NORC at the University of Chicago, Bethesda, Maryland, United States
,
Priyanka J. Desai
1   Department of Health Sciences, NORC at the University of Chicago, Bethesda, Maryland, United States
,
Michael I. Harrison
3   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
James Swiger
3   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
Edwin A. Lomotan
3   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
Chris Dymek
3   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
Prashila Dullabh
1   Department of Health Sciences, NORC at the University of Chicago, Bethesda, Maryland, United States
› Author Affiliations Funding This work is based on research conducted by NORC at the University of Chicago under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSP233201500023I).
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Abstract

Background Clinical decision support (CDS), which provides tools to assist clinical decision-making, can improve adherence to evidence-based practices, prevent medical errors, and support high-quality and patient-centered care delivery. Publicly available CDS that uses standards to express clinical logic (i.e., standards-based CDS) has the potential to reduce duplicative efforts of translating the same clinical evidence into CDS across multiple health care institutions. Yet development of such CDS is relatively new and its potential only partially explored.

Objectives This study aimed to describe lessons learned from a national initiative promoting publicly available, standards-based CDS resources, discuss challenges, and report suggestions for improvement.

Methods Findings were drawn from an evaluation of the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research CDS Initiative, which aimed to advance evidence into practice through standards-based and publicly available CDS. Methods included literature and program material reviews, key informant interviews, and a web-based survey about a public repository of CDS artifacts and tools for authoring standards-based CDS.

Results The evaluation identified important lessons for developing and implementing standards-based CDS through publicly available repositories such as CDS Connect. Trust is a critical factor in uptake and can be bolstered through transparent information on underlying evidence, collaboration with experts, and feedback loops between users and developers to support continuous improvement. Additionally, while adoption of standards among electronic health record developers will make it easier to implement standards-based CDS, lower-resourced health systems will need extra support to ensure successful implementation and use. Finally, although we found the resources developed by the Initiative to offer valuable prototypes for the field, health systems desire more information about patient-centered, clinical, and cost-related outcomes to help them justify the investment required to implement standards-based, publicly available CDS.

Conclusion While the standards and technology to publicly share standards-based CDS have increased, broad dissemination and implementation remain challenging.

Keywords

decision support systems - electronic health records - standards-based CDS - implementation - facilitators and barriers

Protection of Human and Animal Subjects

The evaluation was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the NORC at the University of Chicago Institutional Review Boards.


Authors' Contributions

All authors made substantial contributions to conception, design, and execution of this research. All authors participated in drafting the manuscript or revising it critically for important intellectual content and gave final approval of the version published.




Publication History

Received: 22 December 2022

Accepted: 14 April 2023

Article published online:
26 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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