National Roadmap for Clinical Decision Support
In the summer of 2005, the Office of the National Coordinator for Health Information Technology (ONC) approached the American Medical Informatics Association (AMIA) with a request for a tactical plan to guide federal and private sector activities to advance CDS. AMIA established the CDS Roadmap Development Steering Committee to lead this effort.
The committee developed a framework to organize discussion on the myriad tasks and issues related to CDS. This framework was considered and reviewed in detail during and following an October 2005 workshop in Washington, DC.4 As a result of these discussions, this framework evolved into the three pillars and six strategic objectives for CDS.
Workshop discussions and reviews of draft versions of the Roadmap clarified the vision of next generation CDS capabilities, and provided numerous suggestions for short-term and longer-term activities that will advance CDS. Early discussions of the American Health Information Community (AHIC) workgroups on biosurveillance, consumer empowerment, chronic care, and electronic health records (EHRs) all included reference to CDS functions for their specific breakthrough projects. These discussions also informed the Roadmap development.
In addition, an earlier version of the Roadmap was presented to the American College of Medical Informatics; discussion by this group also validated many of the recommendations in the Roadmap when they were in formative stages.
The Roadmap Development Steering Committee identified a comprehensive set of tasks that would lead to the objective of enhancing health and health care quality through widespread use of robust CDS by consumers, patients, and health care professionals. The Steering Committee used this comprehensive plan in developing a Critical Path for CDS tasks aimed at achieving near term results with a specific focus on increasing effective use of currently available CDS interventions and demonstrating value of and potential for scalable next generation CDS capabilities.
The Roadmap recommends a series of activities to improve CDS capabilities and increase use of CDS throughout the United States health sector. The immediate goal of these activities is to ensure that optimal, usable and effective clinical decision support is widely available to providers, patients, and individuals where and when they need it to make health care decisions. The ultimate goal of these activities is to improve the quality of health care services and to improve health in the United States.
The Roadmap identifies three pillars for fully realizing the promise of CDS:
• Best Knowledge Available When Needed: the best available clinical knowledge is well organized, accessible to all, and written, stored and transmitted in a format that makes it easy to build and deploy CDS interventions that deliver the knowledge into the decision making process
Strategic Objective A: Represent clinical knowledge and CDS interventions in standardized formats (both human and machine-interpretable), so that a variety of knowledge developers can produce this information in a way that knowledge users can readily understand, assess, and apply it.
Strategic Objective B: Collect, organize, and distribute clinical knowledge and CDS interventions in one or more services from which users can readily find the specific material they need and incorporate it into their own information systems and processes.
• High Adoption and Effective Use: CDS tools are widely implemented, extensively used, and produce significant clinical value while making financial and operational sense to their end-users and purchasers
Strategic Objective C: Address policy/legal/financial barriers and create additional support and enablers for widespread CDS adoption and deployment.
Strategic Objective D: Improve clinical adoption and usage of CDS interventions by helping clinical knowledge and information system producers and implementers design CDS systems that are easy to deploy and use, and by identifying and disseminating best practices for CDS deployment.
• Continuous Improvement of Knowledge and CDS Methods: both CDS interventions and clinical knowledge undergo continuous improvement based on feedback, experience, and data that are easy to aggregate, assess, and apply.
Strategic Objective E: Assess and refine the national experience with CDS by systematically capturing, organizing, and examining existing deployments. Share lessons learned and use them to continually enhance implementation best practices. Strategic Objective F: Advance care-guiding knowledge by fully leveraging the data available in interoperable EHRs to enhance clinical knowledge and improve health management.
There are two levels of activity presented in the Roadmap – a comprehensive work plan and a critical path for CDS activities.
The Comprehensive CDS Work Plan outlines the full set of tasks needed to create a robust infrastructure for developing and delivering CDS interventions and an environment that encourages widespread successful use and continual refinement of these interventions.
The Critical Path tasks represent a subset of the comprehensive work plan that can be most readily implemented and produce valuable results in the near term, and that will provide the necessary foundation for subsequent collaborations and investments needed to further build out national CDS capabilities.
The Critical Path Tasks include:
1. Create a focal point for CDS in the form of a Roadmap Execution Steering Group (RESG) that will stimulate, coordinate, and guide CDS efforts outlined in this Critical Path and Roadmap. The RESG mission and structure should address the need for developing and maintaining an ongoing forum for dialogue, consensus, and action by CDS stakeholders.
2. Conduct discussions with specific organizations and initiatives with a role in promoting health care quality (e.g., American Health Information Community (AHIC), Certification Commission for Healthcare Information Technology (CCHIT), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), National Quality Forum (NQF), high profile pay for performance programs) on how CDS can advance their objectives and how such support can, in turn, facilitate execution of the tasks outlined in the Roadmap.
3. Promote dissemination and application of best CDS implementation practices through development and promotion of CDS implementation guides and lessons learned from successful sites as a means of increasing use of currently available CDS interventions.
4. Develop specifications and find funding for a set of coordinated, collaborative projects aimed at demonstrating the feasibility, scalability, and value of a robust approach to CDS using a focused, top priority target. For example, pilot initiatives could include using specific, standardized CDS interventions and integration strategies, and best practice implementation approaches, to increase medication safety or effective management of high-impact clinical conditions such as diabetes or congestive heart failure.
5. Implement at least one of these scalable, outcome-enhancing CDS demonstration projects.
6. Analyze and generalize lessons learned from demonstration projects.
7. Address initial legal, regulatory, and financial issues that impact broader dissemination of CDS.
8. Identify next steps for broader CDS development and implementation as an outgrowth of the activities above.
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VM Nov 19, 2006 (major edit)