Clinical Decision Support Initiative
Effective clinical decision support (CDS) has been shown to be a means of improving health care quality. The Agency for Healthcare Research and Quality (AHRQ) seeks to support efforts to develop, adopt, implement, and evaluate the use of health information technology (health IT) to improve health care decision making. This includes the development, implementation, and integration of health information tools, products or systems through the use of integrated data and knowledge management, such as CDS.
To that end, the AHRQ Health IT Portfolio's CDS Initiative includes a variety of research projects, including two demonstrations supported by a panel of technical experts, and outreach efforts to develop consensus in the health care field around the use of CDS to promote safe and effective health care. Each component of the initiative attempts to engage relevant stakeholders including clinicians, provider organizations, guideline and quality measurement developers, and information technology professionals in the ongoing work to improve health care decision making using CDS systems.
AHRQ has played a key role in recent initiatives to define and execute approaches for more effective Clinical Decision Support (CDS). Despite thoughtful efforts over the last three decades to translate clinical guidelines into CDS rules, there has not been widespread and successful use of such rules to improve patient care. The AHRQ eRecommendations project is a next logical step in this work.
The AHRQ eRecommendations project is aimed at reducing a key barrier to the use of evidence-based clinical care recommendations, namely, the current lack of a formalized process for translating narrative recommendations from prose to an unambiguous, coded format that can then be adopted widely for local conversion into machine-executable CDS rules in various clinical information systems (CIS) and care settings.
View slide presentations describing e-Recommendation project activities:
- Structuring Care Recommendations For Clinical Decision Support
The Brigham and Women's Hospital in Boston, MA and Yale University School of Medicine in New Haven, CT, were selected to conduct the CDS demonstration projects. Under contract, they will:
- Incorporate CDS into electronic medical records that have been certified by the Certification Commission for Health IT (CCHIT).
- Demonstrate that CDS can operate on multiple computer systems.
- Establish lessons learned for CDS implementation relevant to the health IT vendor community.
- Assess potential benefits and drawbacks of CDS, including effects on patient satisfaction, measures of efficiency, cost, and risk.
- Evaluate methods of creating, storing, and replicating CDS element across multiple clinical sites and ambulatory practices.
The demonstrations will focus on translation of clinical guidelines and outcomes related to preventive health care and treatment of patients with chronic illnesses. Clinicians' use of CDS also will be evaluated. It is expected that important lessons from this body of work will further enhance the nation's efforts to make evidence-based clinical knowledge more readily available to health care providers.
- View the Annual Report for AHRQ's CDS Demonstration Projects (PDF, 382 KB).
- View the 2010 Annual Report for AHRQ's CDS Demonstration Projects (PDF, 356 KB).
The latest information on each contractor's approach and activities can be found by clicking on the links below.
The CDS Demonstrations
To advance the understanding of incorporating clinical decision support (CDS) into ambulatory health care delivery, the Agency for Healthcare Research and Quality (AHRQ) sponsored a series of white papers. The series begins with a concise, but comprehensive overview of CDS and its current state, including evidence of its potential impact and its use in clinical settings today. This overview is followed by a thought-provoking piece that explores the use of electronic CDS to improve clinical workflow in ambulatory and hospital-based settings through user-centered design approaches. The third paper in the series, which addresses quality measurement and CDS, is scheduled to be released later this year. Together, the series explores challenges involved with CDS and provides guidance to those developing, implementing, and studying CDS.
Below are highlights of the first two papers in this series:
Clinical Decision Support Systems: State of the Art (PDF, 184 KB).
Eta S. Berner, Ed.D., University of Alabama at Birmingham
- CDS, when well-designed and implemented, holds great potential to improve health care quality, increase efficiency, and reduce health care costs.
- Failure to attend to CDS alerts and recommendations poses challenges for those developing, implementing, and using CDS.
- Researchers and vendors alike should address cognitive, informatics, structural, and workflow issues to optimize CDS design, implementation, and integration into clinical workflow.
Clinical Practice Improvement and Redesign: How Change in Workflow Can Be Supported by CDS (PDF, 634 KB).
Ben-Tzion Karsh, Ph.D., University of Wisconsin-Madison
- The goal of widespread use of CDS in ambulatory care has not yet been realized.
- Successful integration of CDS into clinical workflow requires effort and user involvement.
- There are a range of techniques available to researchers to define and measure workflow fit that will lead to innovations in CDS design and implementation.
- User-centered design approaches can be used by developers and implementers to ensure that CDS works for a range of users, their diverse needs, and in a range of contexts of use.
To further its mission of supporting the use of health information technology (health IT) to drive improvements in health care outcomes, the Agency for Healthcare Research and Quality (AHRQ) is providing online access to the first chapter of Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide, which is designed for implementers of clinical decision support (CDS) tools. Chapter 1 of this new guide outlines foundational elements for applying CDS to medication management, including:
- The 'CDS Five Rights' approach (getting the right information to the right stakeholder, at the right point in workflow, through the right channel, and the right format).
- Steps in the medication management cycle and opportunities for applying CDS to improve medication use and outcomes.
- Current and desired future states of CDS use for medication management.
- An overview of the CDS medication management literature.
To read the first chapter, visit http://healthit.ahrq.gov/cdsguide.
AHRQ produced a series of three podcasts on CDS in late 2009 as a part of its "Healthcare 411" news series. The links to each podcast are provided below:
- Clinical Decision Support - Improving Health Care Quality
October 21, 2009
- Clinical Decision Support White Papers
November 4, 2009
- Clinical Decision Support and Improving Patient Outcomes
November 18, 2009
In November 2008, the American Medical Informatics Association (AMIA) convened a CDS Town Hall Meeting at the request of AHRQ. The meeting aimed to stimulate a discussion of the current CDS environment and options for future efforts to promote CDS adoption.
A summary report on the meeting and its outcomes is available for download. (PDF, 112 KB).
A new report examines the challenges and barriers to implementing clinical decision support (CDS) and found workflow, design and clinician's level of support are just some of the issues that can affect successful CDS implementation. Challenges and Barriers to Clinical Decision Support (CDS) Implementation (PDF, 254 KB) describes the challenges and barriers that AHRQ contractors encountered as part of their CDS demonstration project. These challenges and barriers can be successfully addressed by employing several key strategies, which include utilizing standard data exchange formats, providing clinicians with appropriate training, and modifying CDS to address clinicians' needs.