Email UpdatesWhat is clinical decision support and why is it important?
Clinical decision support (CDS) provides timely information, usually at the point of care, to help inform decisions about a patient's care. Clinical decision support can effectively improve patient outcomes and lead to higher-quality health care. CDS can take many forms, such as order sets, recommendations about needed care like screening tests, dashboards that can provide summary information, and alerts that need attention from care team members. CDS can potentially lower costs, improve efficiency, and reduce patient inconvenience. In fact, CDS can sometimes address all three of these areas at the same time—for example, by alerting clinicians about possible duplicate tests a patient may be about to receive.
In addition to “traditional” clinician-facing CDS, there is a type of CDS that focuses on the patient (or caregiver) – called patient-centered CDS or PC CDS – that facilitates their active involvement in healthcare decision-making with their clinicians. PC CDS uses information from patient-centered outcomes research (PCOR) findings and/or patient-specific information and has the potential to be transformative by enabling higher-quality care delivery and improved outcomes. AHRQ describes PC CDS in the infographic here, outlining how PC CDS significantly incorporates multiple patient-centered factors, including the areas of knowledge, data, delivery and use. PC CDS is a developing field and has the potential to increase the quality and experience of patient care.
What is Patient-Centered Outcomes Research CDS (PCOR CDS) at AHRQ?
In 2010, the United States Congress passed the Patient Protection and Affordable Care Act (or ACA). Within the text of the law in section 6301, AHRQ is required to conduct research on clinical decision support. Specifically, this section has two parts: (1) to incorporate research findings in a timely manner through clinical decision support tools, while promoting the ease of use of these findings, and (2) to establish a process to receive feedback from physicians, health care providers, patients and vendors of health IT who are focused on CDS. AHRQ must also assess the value of this information and how it is used. The ACA also created the Patient Centered Outcomes Research Trust Fund (PCOR TF). Alongside other AHRQ PCOR-funded dissemination, implementation, and training activities that are guided by AHRQ’s PCOR TF strategic framework, the PCOR CDS program specifically focuses on advancing PCOR findings into practice through CDS, in alignment with the legislative mandate.
After initial planning, AHRQ began its PCOR CDS Initiative in 2016. To meet the ACA legislative mandate around CDS, the CDS program, which is part of AHRQ’s Center for Evidence and Practice Improvement, in the Division of Digital Healthcare Research created four “pillars” of research areas. These pillars include (1) Engaging a stakeholder community; (2) Creating a prototype infrastructure for sharing CDS and developing CDS; (3) Advancing CDS through grant-funded research; and (4) Evaluating the overall Initiative, as shown below.
AHRQ has funded the creation of a variety of tools, prototypes, frameworks, and other resources that can be used to advance the field of PCOR CDS. Below is a selection of AHRQ PCOR CDS resources that can serve as a starting point for future CDS concepts, either in traditional or patient-centered CDS contexts.
List of AHRQ PCOR CDS Resources
| Title | Link | Description |
|---|---|---|
| CDS Connect | The CDS Connect Project is a freely available web-based platform that enables the clinical decision support (CDS) community to identify evidence-based care, translate and codify information into an interoperable health IT standard, and leverage tooling to promote a collaborative model of CDS development. It has two components, an authoring tool, and a repository.
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| CDS Connect Maintenance | This effort continued to develop CDS Connect and create a community to share knowledge and resources. Specifically, the aims included: 1- Ensuring the platform was current with standards and guidelines; 2 - Continuing the CDS Connect Work Group; 3 - Developing recommendations for future functionality; 4 - Providing a forum for CDS Connect users. | |
| CDS Connect - Authoring tool | Link to Authoring Tool | The CDS Authoring Tool provides an interface for creating clinical decision support logic using simple forms and exporting it as Health Level Seven (HL7) Clinical Quality Language (CQL) artifacts using the HL7 Fast Healthcare Interoperability Resources (FHIR®) data model for integration with EHRs. |
| CDS Connect – Repository | Link to CDS Artifacts | The CDS Connect Repository supports AHRQ’s mission to disseminate and implement patient-centered outcomes research findings into clinical practice through clinical decision support (CDS).
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| PC CDS Learning Network | Link to collaborative | Later renamed the Patient-Centered Clinical Decision Support Learning Network (PCCDS-LN or “the Learning Network”), it created as a multistakeholder collaborative to address barriers and facilitators around PC CDS, to formulate recommendations, and to take action to improve the adoption and use of PCOR-based CDS.
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| Quantifying Efficiencies Gained through Shareable CDS resources | Link to report | For this research, AHRQ contracted with 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. |
| PCOR CDS: Current State and Future Directions | Link to evaluation | This project conducted an evaluation of the value and quality of various PCOR CDS projects, relative to the ACA mandate. This effort designed and executed a comprehensive evaluation of the first few years of AHRQ’s PCOR CDS Initiative. It also conducted a horizon scan to explore the current and future opportunities around PC CDS. In addition to conducting multiple Technical Expert Panels (TEPs) of stakeholder experts, it conducted two pilot projects to test research questions around PC CDS and explored implementation of these. It authored several publications (see publications tab in link). |
CDS for Chronic Pain Management (CDS Connect) | Link to Artifact | This artifact provides relevant information (i.e. factors) to inform decision-making when managing a patient’s chronic pain. The information is presented to the clinician as a Pain Management Summary. This project developed and demonstrated use of a dashboard in the EHR that helps clinicians work with patients to manage their chronic pain.
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CDS for Chronic Pain Management (RTI) | Link to reports | This project contributed to HHS’s efforts to address the opioid overdose epidemic. Building on the earlier CDS connect research, it leveraged Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standards. It explored methodologies to identify patients at highest risk of opioid overdose or other adverse outcomes from opioids.
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CDS for Chronic Pain Management (Medstar) | Link to reports | This project contributed to HHS’s efforts to address the opioid overdose epidemic. Building on the earlier CDS connect research, it leveraged Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standards. It explored methodologies to identify patients at highest risk of opioid overdose or other adverse outcomes from opioids.
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| CEPI Evidence Discovery and Retrieval Project (CEDAR) | Link to resource | Focused on dissemination of evidence-based research findings, the goal of CEDAR was to make PCOR findings within AHRQ repositories more FAIR through technologies used by clinicians, researchers, implementers, patients, and others. Specifically, this work developed prototype infrastructure that demonstrated standards-based, application programming interface (API)-enabled discovery and retrieval of underlying PCOR findings within CEPI repositories. |
| CDS Innovation Collaborative (CDSiC) | Stakeholder Center Workgroup Products (begins mid-way down page) | The CDSiC is an ongoing learning collaborative that is advancing the concept of PC CDS by creating a foundation of PC CDS resources and bringing together patients, developers, clinicians, and others through workgroups, demonstration projects, and an annual meeting. The CDSiC is strategically organized into 3 Centers.
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Grants
| Title | Type | Link | Description |
|---|---|---|---|
| AHRQ-funded CDS Demonstration grants (U18) | Reports Grantee information | NOFO: PA-18-792
HS 026849 (Dorr) HS 027099 (Malone) HS 027557 (Dykes) | These grantees under a cooperative agreement, focus innovative research that disseminates evidence into practice through shared, interoperable clinical decision support (CDS) resources |
| AHRQ-funded CDS demonstration grants (R18) | Reports Grantee information | NOFO: PA-20-074
R18 HS028584 (Harle, Salloum) R18 HS028579 (Dorr, Koopman) R18 HS028791 (Kawamoto) R18 HS028583 (Tiganelli, Melton-Meaux) R18 HS028578 (Schilling, Soares) R18 HS028787 (Dorsch) R18 HS028616 (Lacson) R18 HS029300 (Malone) R18 HS028955 (Dean, Langlotz & Ward) | These grantees focus on projects that disseminate and implement patient-centered outcomes research evidence in clinical practice by scaling computer-based, interoperable clinical decision support. |
| Other AHRQ-funded CDS research | Reports Grantee information | Search DHR’s funded CDS projects. Select ‘clinical decision support system.’ | Showcases various other CDS grant research, including projects launched before the PCOR CDS Initiative. This search includes the PCOR CDS funded grantees under both the U18 (3 awards) and R18 (9 awards) mechanism, noted above. |