AHRQ Views: Blog posts from AHRQ leaders
Enhancing the Use of Evidence with Interoperable Clinical Decision Support
Today’s medical discoveries and technological advancements suggest we are approaching an exciting new era of patient care. Central to this vision is the successful—and seamless—implementation of health information technologies, from electronic health records (EHRs) to machine learning to patient-facing apps.
Imagine this scenario: A 50-year-old male patient with elevated cholesterol but no family history of heart disease asks his physician whether he should begin taking a statin to prevent a heart attack or stroke. The physician clicks on the patient’s chart in the EHR, where she quickly accesses a clinical decision support (CDS) tool that incorporates the latest practice guidelines, peer-reviewed articles, and local best practices. Together, the physician and patient view evidence-based recommendations on a shared screen and see that statin therapy isn’t generally needed for someone with his specific history and risk factors. An unnecessary treatment is avoided.
Unfortunately, translating the latest evidence-based recommendations via effective, well-implemented computerized tools is a complicated, labor-intensive process. Another hindrance is that healthcare systems tend to develop CDS independently from each other, even though they are all starting from the same set of evidence and clinical practice guidelines and are all working toward achieving the same goal.
As a clinician myself, I understand that it’s nearly impossible to keep up with the never-ending deluge of research findings. Physicians and patients need better ways to access, understand, and apply the latest evidence in a way that meets individual needs.
Today, our vision of CDS and its potential to improve care is closer than ever. We’re developing the right tools for healthcare systems to learn from each other without starting from scratch when they translate evidence-based care recommendations into CDS that functions within EHRs and other technology platforms.
Central to this effort is AHRQ’s CDS Connect project, which aims to make CDS more shareable, interoperable, and publicly available. Funded by AHRQ and launched in 2016, CDS Connect includes an online repository of resources that identify evidence-based standards of care on a wide range of medical conditions and translate this information into interoperable, reusable computer code.
CDS Connect is the result of broad collaboration. Developed under a contract with the MITRE Corporation, it includes input from:
- Clinicians and provider organizations, which identify relevant medical knowledge from a variety of sources to create what’s known as CDS “artifacts.” Artifacts are drawn from evidence-based guidelines, peer-reviewed articles, and best practices. They are the building blocks for new CDS tools.
- Federal agencies that are also aiming to improve clinical practice and care delivery through CDS that can be used across multiple platforms and technologies.
- Health information technology (HIT) developers, who create the CDS tools that are used in EHRs and pilot-test tools in organizations.
- Patients, academic researchers, community health centers, and many others.
CDS Connect is a publicly available repository, an online platform for a larger community of stakeholders to contribute and reuse CDS artifacts. Importantly, the artifacts are accompanied by a narrative about their development, including their testing and history. This is critical because healthcare systems looking to use the artifacts need to understand their origins before making adjustments for their specific patient populations.
Because CDS Connect relies on the international Health Level-7 standards for the exchange of clinical data and related CDS logic (including Fast Healthcare Interoperability Resources and Clinical Quality Language), the CDS artifacts are interoperable across EHRs and any other technologies that use those standards.
To demonstrate the use of the platform and its associated tools, CDS Connect also develops CDS within the project. Working with AllianceChicago and OCHIN, we’ve developed CDS for preventing cardiovascular disease and for chronic pain management. This year we are working with b.well Connected Health to deliver U.S. Preventive Services Task Force recommendations directly to consumers through b.well’s innovative patient-facing platform.
We are gratified to learn that others share our enthusiasm for CDS Connect. The project has been nominated for a 2019 national innovation award by the American Council for Technology and Industry Advisory Council. The group will announce its winner later this month.
We’re excited about the progress CDS Connect has made so far, and we look forward to sharing more news about how this resource is inspiring new ideas and creating new strategies to increase the use of evidence for better patient care.
Edwin Lomotan is Medical Officer and Chief of Clinical Informatics at the Center for Evidence and Practice Improvement.