A National Repository of Widely-Shareable, Computable Clinical Decision Support
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1 A National Repository of Widely-Shareable, Computable Clinical Decision Support Session 199, March 8, 2018 Edwin Lomotan MD, Medical Officer & Chief of Clinical Informatics, AHRQ Rob McCready, Portfolio Manager Learning Health Systems, MITRE 1
2 Conflict of Interest Edwin Lomotan, MD Rob McCready Has no real or apparent conflicts of interest to report. 2
3 Agenda Overview of AHRQ's Clinical Decision Support efforts Clinical Decision Support Primer ConOps for AHRQ CDS Connect environment HL7 Clinical Quality Language Standard CDS Development Processes and Governance Public Work Group Future Evolution of CDS: CDS as a Service 3
4 Learning Objectives Evaluate pros and cons of shareable CDS that can be held and maintained in a common repository Recognize how to transform clinical guideline statements into precise, computable CDS Explain key considerations in authoring, searching, and accessing publiclyavailable CDS Apply CDS from a standard source for use in your own Health IT environment Discriminate among similar, but conflicting, guidance when choosing CDS for your own organization 4
5 AHRQ Clinical Decision Support Agency for Healthcare Research and Quality (AHRQ) has a long history of investment in CDS 2016 initiative based on patient-centered outcomes research and ACA legislative requirements (Sec 6301) (b) INCORPORATION OF RESEARCH FINDINGS. The Office [AHRQ/OCKT], in consultation with relevant medical and clinical associations, shall assist users of health information technology focused on clinical decision support to promote the timely incorporation of research findings disseminated under subsection (a) into clinical practices and to promote the ease of use of such incorporation. (c) FEEDBACK - The Office shall establish a process to receive feedback from physicians, health care providers, patients, and vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans about the value of the information disseminated and the assistance provided under this section. 5
6 Current AHRQ CDS Initiative Advancing evidence into practice through CDS and making CDS more shareable, standards-based, and publicly-available Four components: 1. Engaging a stakeholder community 2. Creating prototype infrastructure for sharing CDS and developing CDS 3. Advancing CDS through demonstration and dissemination research 4. Evaluating the overall initiative 6
7 Mission: Demonstrate a system that supports New evidence-based standards of care Codifies Clinical Decision Support (CDS) artifacts based on those standards using an interoperable, international data standard Shares the resulting CDS capabilities via an accessible, web-based tool 7
8 What is Clinical Decision Support (CDS)? Process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve healthcare outcomes and healthcare delivery 8
9 The CDS Five Rights Framework Clinical decision support delivers: 1. The right information 2. To the right person 3. In the right format 4. Through the right channel 5. At the right time Reference: Osheroff J.A., Pifer E.A. Teich J.M. et. al. Improving Outcomes with Clinical Decision Support: An Implementer s Guide, 2 Ed. Danvers, MA: HIMSS Publishing, Taylor & Francis Group/CRC Press,
10 Activities: 1. Repository: Design and build an online software repository for hosting and sharing new CDS artifacts 2. Authoring: Build a public facing, web-based CDS Authoring tool geared toward nontechnical users 3. Artifacts: Identify and codify new CDS artifacts for care, in the domain of pain management and opioids 4. Pilot: Pilot CDS artifacts in a live, clinical setting 5. Work Groups: Convene external discussions focused on accelerating evidence into practice through CDS Sponsor: Agency for Healthcare Research and Quality 10
11 Concept of Operations 11
12 Concept of Operations 12
13 13
14 Concept of Operations 14
15 15
16 Concept of Operations 16
17 What is the Clinical Quality Language (CQL)? The Clinical Quality Language Specification defines a representation for the expression of clinical knowledge that can be used within both the Clinical Decision Support (CDS) and Clinical Quality Measurement (CQM) domains. Reference: HL7 Standard: Clinical Quality Language Specification, DSTU Release 1. 17
18 What is the Clinical Quality Language (CQL)? 18
19 CQL Key Points The CQL specification defines two components: Clinical Quality Language: Author-friendly domain specific language Expression Logical Model: Computable XML or JSON CQL leverages best practices and lessons learned from: Quality Data Model: Focus on ease of authoring Health edecisions: Focus on modularity and computability ecqm & CDS Communities: HL7 Work Groups and S&I Framework CQL is designed to work with any data model 19
20 CQL Example: Last Systolic Blood Pressure 20
21 CDS Governance 21
22 CDS Artifact Development Identify and develop new CDS artifacts for initial content of the CDS Connect Repository Drives CDS Repository and CDS Authoring Tool software requirements Provides an example to potential contributors to the CDS Repository 2017: Development focused in the clinical domain of cholesterol management 2018: Development focused in the clinical domain of opioids and pain management Embracing a self-service user model Encouraging the CDS Connect community to contribute content directly on the CDS Repository, and through the CDS Authoring Tool 22
23 Example: American College of Cardiology and American Heart Association Baseline Risk Model Binomial inputs Current smoker (yes/no) Diabetes (yes/no) Treated for high blood pressure (yes/no) Multinomial inputs Age (years) Total cholesterol (mg/dl) HDL cholesterol (mg/dl) Systolic blood pressure (mm Hg) 23
24 Potential Future Evolution: CDS as a Service With a Repository and machine-computable CDS artifacts, clinical practices will be able to: Download and integrate these CDS artifacts into health IT systems more rapidly Adapt to changing clinical standards of care through the interoperable definition of CDS Better support the concept of the Learning Health System by embedding within the clinical delivery process, all the new knowledge captured as by-product of the healthcare delivery experience 24
25 Potential Future Evolution: CDS as a Service 25
26 Questions AHRQ CDS Initiative AHRQ CDS funding opportunities: Contact information 26
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