Challenge

Clinical Decision Support (CDS) is the user facing representation of clinical guidance. Effective CDS interventions require availability of computable biomedical knowledge, person-specific data, and a reasoning or inference mechanism that combines these elements to generate and present helpful and actionable information to clinicians, individuals, or caregivers in the right way – at the right time. In order to optimize these benefits, CDS interventions must be made more easily shareable and implementable so that any organization can easily acquire and deploy CDS interventions. To this end, standards must be advanced to enable either the routine or regular consumption of CDS interventions through a Web service or the repeated import and update of CDS artifacts into CDS systems.

Scope Statement

To identify, define and harmonize standards that facilitate the emergence of systems and services whereby shareable CDS interventions can be implemented via:

• Standards to structure medical knowledge in a shareable and executable format for use in CDS, and
• Standards that define how a system can interact with and utilize an electronic interface that provides helpful, actionable clinical guidance

In order to facilitate integration of a system with CDS interventions, the scope includes standards to refer to data in electronic health records and standards to map recommendations to locally implementable actions.

Value Statement

Health information technologies designed to improve clinical decision making are particularly attractive for their ability to address the growing information overload clinicians face and to provide a platform for rapidly incorporating knowledge into care delivery.
Standardized expressions of Clinical Decision Support have a number of important benefits including:

• Increased quality of care and enhanced health outcomes for individuals and populations
• Improvement in workflow
• Avoidance of errors and adverse events
• Improved efficiency, cost benefit, and provider and patient satisfaction
• Reduced latency for incorporating new clinical knowledge and evidence-based guidelines into clinical practice

Focusing the S&I Framework community on Clinical Decision Support through the Health eDecisions Initiative will enable the translation of interventions into implementable components, increasing the speed and ease of adoption by the provider community.

Implementation Guide Resources

HL7 Artifacts

Target Outcomes

• Alignment with Meaningful Use
  • The product of this initiative will help providers achieve meaningful use of HIT and their quality improvement goals through addressing a known barrier to CDS development, adoption, and implementation
• Repositories or catalogues can emerge, supplied by a range of content creators such as societies or content vendors, whereby CDS artifacts can be selected and imported into HIT systems
  • Each intervention will represent a standardized expression of a guideline that can be accessed by EHR system developers and users to simplify the process of incorporating guidelines into EHRs
• Clinical Decision Support Services can interact with EHRs and/or other Health Information Technology implementations
• Alignment with other S&I Initiatives, e.g., Query Health (HQMF)
• Close the gap between standard availability and widespread use/value
• Perform outreach to medical professional societies and guidance authors to promote their development of CDS interventions in addition to traditional guideline publications
  
  

Timeline

Updated version of the deliverables and timeline can be found on the Health eDecisions Homepage

Pre-Discovery: Complete Call for Participation Discovery (Phase I): In Progress Finalize Project Charter Construct Use Cases & Functional Requirements Analyze Standards Gaps Engage Appropriate SDOs Implementation (Phase II): Summer / Fall 2012 Create Harmonized Specifications Conduct Technology Evaluations Generate Reference Implementations Design Pilot Plan Pilot (Phase III): Winter / Spring 2013 Create Pilot Technology Validate / Revise Specifications and Implementations Evaluation (Phase IV): Spring 2013 Assess Outcomes Present Final Recommendations