Quantifying Efficiencies Gained through Shareable Clinical Decision Support Resources

Clinical decision support (CDS) is a process of providing the right information, to the right audiences, in the right formats, through the right channels, at the right times, referred to as the “Five Rights” of CDS. More than just alerts and reminders, computerized CDS weaves together people and technology and, when implemented successfully, can improve quality of care. Clinicians at the point of care are often the target audience for CDS, but other members of the care team, including patients and families themselves, may also use CDS.

The development and implementation of CDS is often long and resource-intensive. The process usually begins with the need to address a known gap in quality of care. A key step is the translation of evidence-based knowledge, for instance clinical practice guideline recommendations, into a computer-interpretable format. After the CDS is implemented in an electronic health record (EHR) or other technology, it is tested, refined, and deployed for use in clinical practice. Currently, each institution or healthcare system in the United States that manages its own EHR undertakes this translation of evidence into CDS in a siloed fashion.

A systematic and replicable approach to developing and implementing CDS could reduce costs to healthcare systems if supported by shareable, interoperable, standards-based tools and resources. For instance, there are opportunities to standardize tools for authoring CDS, structured representations of guidelines that are machine-readable, standards-based logic specifications, and implementation guidance. Healthcare systems would not have to start from the beginning when developing and implementing CDS.

To support these goals, in 2016 AHRQ launched CDS Connect, a prototype infrastructure for sharing CDS resources. It includes a repository of publicly accessible, reusable CDS resources for sharing among CDS implementers. For this research, AHRQ contracted MedStar Health Research Institute (National Center for Human Factors in Healthcare) to evaluate the CDS lifecycle in its current state (the “Isolated CDS Build”) to the future state (the “Shareable CDS Resources Build”) through the application of the tools available on the AHRQ CDS Connect platform. The implementation and testing was conducted at four healthcare systems, representing different patient populations and two EHR vendors to facilitate a robust evaluation process. This systematic approach will allow for analytic comparisons within sites and between sites to test the efficiencies of shareable CDS resources.

The specific aims of the research were as follows:

• Understand the role of shareable CDS resources in CDS development and implementation, including the healthcare systems perspective.
• Gain understanding of shareable CDS resources available through AHRQ’s CDS Connect, including describing and quantifying efficiencies gained by a healthcare system.

Key findings included:

• CDS projects and tools vary significantly based on site, EHR platform, and complexity of clinical conditions being addressed, which makes comparisons of CDS development and implementation between sites very challenging.
• Within each site, the need for CDS – and consequently the processes for approval, development, and implementation – can arise from different organizational pathways, such as quality improvement activities, research, and operational priorities.
• CDS teams do not typically track time spent on individual projects, which makes comparisons between isolated and shareable CDS projects difficult.
• Trust and transparency are important aspects of sharing CDS resources. Healthcare systems may be more likely to adopt externally-developed CDS resources, for example, if there is comprehensive information about its development and history.
• The overall technical maturity of a CDS resource (e.g., its use of value sets and standards) will likely affect its potential for re-use.
• CDS Connect as a platform could be improved by enhancing its organization, making it easier to author new technical resources, and increasing the availability of instructional and “how-to” material.