Improving quality of care through clinical decision support (CDS) takes a community

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Clinicians and Provider Organizations
Discover interoperable CDS and learn from others’ experiences.
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Health IT Vendors
Build upon the CDS resources that are available. Use the open source testing and authoring tools. Participate in the community to help shape the Repository.
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Federal Health Research Organizations
Promote a collaborative model of CDS development. Contribute to the Repository to help disseminate computable, evidence-based resources.
CDS Connect is a place for the development and exploration of clinical decision support.
Through the CDS Connect Project, MITRE’s Health FFRDC piloted a process that accounts for the agile nature of CDS development, including clinical and technical translation of guidelines into computable CDS, testing and monitoring, implementation protocols, and feedback loops. For more information see each year’s final report.
CDS lifecycle chart

The CDS Connect lifecycle begins with the CDS community, which identifies a need for a new CDS artifact. The artifact is then built through CDS authoring, whose sources include clinical practice guidelines, peer-reviewed articles, local best practices, and Clinical Quality Measures (CQMs). From there, the artifact is published on the Repository. At this point, the artifact is implemented in health IT systems and feedback is collected, which is then used to improve the artifact for the CDS community to use.

Actionable tools for management of common clinical scenarios.
Initial CDS artifact development work was focused in the domain of cholesterol management. Subsequent work involved the development of a clinician-facing summary of patient-specific information relevant to the management of chronic pain. These artifacts have been designed to provide actionable, highly relevant clinical decision support. Prior to upload to the publicly accessible Repository, the artifacts developed under the CDS Connect project have undergone feasibility testing that includes clinical and operational assessments in live clinical environments. Feasibility test results are outlined in the Pilot Report for each CDS Connect artifact.
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Pain management summary (artifact)
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An example artifact page
CDS artifacts standardize proven techniques in the practice of medicine for the best patient outcomes.
The Repository offers structured data, aggregated resources, and the ability to leverage the international standard Clinical Quality Language (CQL). Features and functions of the Repository are being guided by the needs of a diverse set of stakeholders serving on the project’s Work Group.

Through the Repository, CDS contributors and consumers will have unparalleled and equal access to knowledge driven by cutting edge research in CDS, as well as clinical and regulatory standards. Additionally, organizations that work to balance limited resources will be able to leverage advanced technical resources and secure information critical to the CDS implementation process.

Knowledge Levels

Each artifact has a knowledge level (Boxwala et al. JAMIA vol. 18 Suppl 1, 2011). This represents both the maturity and the readiness of the artifact to be implemented into a real-world clinical setting.

artifact knowledge levels
  1. Narrative text created by a guideline or CQM developer.
  2. Semi-structured text that describes the recommendations for implementation in CDS.
  3. Structured code that is interpretable by a computer (includes data elements, value sets, logic).
  4. Executable code that is interpretable by a CDS system at a local level. This will vary for each site.
The leaders behind CDS Connect
The Agency for Healthcare Research and Quality (AHRQ) has long supported efforts to develop, adopt, implement, and evaluate clinical decision support. The CDS Connect project, led by the CMS Alliance to Modernize Healthcare (Health FFRDC), a federally-funded research and development center operated by The MITRE Corporation, is part of an AHRQ initiative to advance patient-centered outcomes research findings into clinical practice through clinical decision support.

Other components of the initiative include a PCOR CDS Learning Network, funding opportunities for grants to scale and develop CDS, and an evaluation.
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