Executive Summary

Clinical decision support continues to advance through a combination of technical innovations, increased data availability, and evolving healthcare needs. AHRQ's CDS Connect platform, initiated in 2016, aims to expedite the application of patient-centered research into clinical practice, by serving as a trusted resource for open-source clinical decision support artifacts and development tools. In its eighth year, the project focused on maintaining and updating its artifacts and tools to ensure they remain shareable, standards-based, and publicly accessible. The project’s capabilities within the Repository, Authoring Tool, open-source tools, and CDS artifacts contribute to the rapid incorporation of evidence-based care into clinical settings. Significant accomplishments this year include upgrading system components, enhancing security measures, and expanding user documentation and account management.

Executive Summary

This year’s report details the project’s efforts relating to the Repository, Authoring Tool, open-source tools and CDS artifacts.  Highlights include developing a Repository User Guide and updating the CDS artifact Implementation Guides, which cover the topics of mitigating the risk of cardiovascular disease, pain management, diabetes, and statin use.  Recommendations, lessons learned and next steps in the transition are identified.  The report concludes with project resources to encourage readers to engage with the project and its transition activities.

Executive Summary

Healthcare is undergoing a digital revolution that will lead to innovations in using technology and data to impact care. As part of the Agency for Healthcare Research and Quality’s (AHRQ’s) clinical decision support (CDS) initiative, the CDS Connect project was launched in 2016 to put patient-centered outcomes research (PCOR) findings into practice. CDS Connect provides a web-based public platform for integrating evidence-based care more rapidly into clinical practice through electronic health systems.

The sixth year of the CDS Connect project initially focused on system maintenance and updates to ensure that the tools remained shareable, standards-based, and publicly available, with a shift after the first quarter of the project to supporting other AHRQ initiatives. This annual report organizes the project’s year-long accomplishments into four task areas: Task Management, Trust Framework, Standards Conformance, and Outreach.

Task Management (Manage Project Resources; Section 2)

With reduced tasking in Year 6 the CDS Connect project team (hereafter “the team”) was leaner, primarily with a single lead and support staff across respective tasks.

Trust Framework (Prioritize Activities Based on Promotion of Trust; Section 3)

The team engaged with end users and other stakeholders to identify and prioritize updates. This activity resulted in a framework focused on two primary “must have” themes and one secondary “should have” theme for CDS Connect updates.

The primary themes were “must have”—

• Enforce Standards Compliance (CDS Artifacts): Update CDS artifacts already in the Repository to ensure compliance with applicable standards.

Other themes were evenly supported, including “Expand the Repository,” “Increase Trust,” and “Expand the Use of Existing Artifacts.”

Standards Conformance
(Ensure that Tools Adhere to Standards and are Innovative; Sections 4 – 7)

CDS Connect tools and artifacts are more likely to be used if they adhere to existing, widely accepted standards and if they include useful innovations for end users. During this period of maintenance and update, the team introduced the following improvements based on the selected themes in the Trust Framework task:

• Implemented a standardized process to review and update (where needed) all CDS artifacts in the CDS Connect Repository.

• Updated CDS Connect project artifacts to follow best practices for Clinical Quality Language (CQL) development and reflect evidence updates from trusted clinical sources.

• Upgraded the CDS Connect Repository to Drupal 9 for ongoing vendor support.

• Developed the Repository User Guide.

• Created tiles and landing page for Clinical Decision Support Innovation Collaborative (CDSiC) project.

• Enhanced CDS Authoring Tool capabilities related to FHIR versions, artifact downloads, system integration, usability, and maintainability.

• Continued to maintain open-source software offerings to use latest libraries, including updated libraries for CQL execution.

• Continued the “Lessons Learned” series for the CDS Connect Work Group (WG), a community of more than 140 CDS members who provide diverse perspectives and help the team identify and prioritize key features and capabilities for CDS Connect.

Outreach (Engage with the CDS Community; Section 8)

Engaging with the CDS community through various channels promotes adoption of CDS Connect and increases use of the resources. During Year 6, the team continued to adapt to varied engagement formats and redirection from AHRQ on CDS community needs. The team engaged with the CDS community in the following ways:

• Participated in one in-person conference at the start of the year, with a focus on the use of CQL and the CDS Authoring Tool.

• Developed handouts and prioritized patient partnering in CDS through expansion of the Patient-Partnering Panel held during Year 5 of the project.

Collaborated and supported AHRQ’s CDSiC project and technical migration to Amazon Web Servicers (AWS) secure enclave.

These accomplishments during Year 6—primarily in the areas of prioritization of CDS needs in development and implementation, particularly with patient partnering—will enable the team to further its success in any possible future phases of the CDS Connect project.

Executive Summary

Healthcare is undergoing a digital revolution that will lead to innovations in using technology and data to impact care. As part of the Agency for Healthcare Research and Quality’s (AHRQ’s) clinical decision support (CDS) initiative, the CDS Connect project was launched in 2016 to put patient-centered outcomes research (PCOR) findings into practice. CDS Connect provides a web-based public platform for integrating evidence-based care more rapidly into clinical practice.

The fifth year of the CDS Connect project1 focused on system maintenance and updates to ensure that the tools remained shareable, standards-based, and publicly available. The team also focused on ensuring that the project’s activities and work product accurately reflect the needs of the community—addressing the perspectives of patients and caregivers as well as the needs of clinicians and content developers. This annual report organizes the project’s year-long accomplishments into four task areas: Task Management, Trust Framework, Standards Conformance, and Outreach.

Task Management (manage project resources; Section 2)
New staff with development expertise joined the CDS Connect project team (hereafter “the team”) to promote the adoption of standards and implementation of CDS Connect’s offerings.

Trust Framework (prioritize activities based on promotion of trust; Section 3)
The team engaged with end users and other stakeholders to identify and prioritize updates. This activity resulted in a framework focused on two primary “must have” themes and one secondary “should have” theme for CDS Connect updates.
Two primary themes were “must have”—

1. Enforce Standards Compliance (CDS Artifacts): Update CDS artifacts already in the Repository to ensure compliance with applicable standards

2. Expand the Use of Existing CDS Artifacts: Improve usability and update the Repository to support expanded use of existing CDS artifacts.

Another secondary theme was differentiated from the others as “should have”—

3. Increase Trust: Implement recommendations from the Trust Framework Work Group (WG).Standards

Conformance (ensure that tools adhere to standards and are innovative; Sections 4-7)
CDS Connect tools and artifacts are more likely to be used if they adhere to existing, widely accepted standards and if they include useful innovations for end users. During this period of maintenance and update, the team introduced the following improvements based on the selected themes in Trust Framework task:

• Implemented a process to review and update (where needed) all CDS artifacts in the CDS Connect Repository.
• Updated CDS Connect project artifacts to use the Fast Healthcare Interoperability Resources (FHIR®) Release 4 (R4) data model and follow best practices for Clinical Quality Language (CQL) development.
• Applied Clinical Practice Guidelines (CPG)-on-FHIR® to the Repository to ease their implementation by the CDS community.
• Upgraded the CDS Connect Repository to Drupal 9 for ongoing vendor support.
• Updated and enhanced CDS Application Programming Interface (API) to facilitate access to integrate tools with CDS Connect.
• Upgraded open-source software offerings to align more closely with CQL 1.5.
• Continued the “Lessons Learned” series for the WG, a community of more than 150 CDS members who provide diverse perspectives and help the team identify and prioritize key features and capabilities for CDS Connect).

Outreach (engage with the CDS community; Section 8)
Engaging with the CDS community through various channels promotes adoption of CDS Connect and increases use of the resources. During Year 5, the team continued to adapt to varied engagement formats, innovated its outreach based on limitations posed by the COVID-19 pandemic, and sought diverse outlets to interact with the CDS community. The team engaged with the CDS community in the following ways:

1. Participated in four virtual conferences throughout the year, with a focus on practical engagements that directly impact CDS Connect (e.g., immediate use or improvement).
2. Expanded its practices to track visit and download metrics across CDS Connect tools.
3. Pursued a collective effort to encourage patient partnering in CDS development and implementation (including site updates, WG discussions, and panel).
4. Delivered periodic updates to the CDS community through opt-in email notification.

These accomplishments during Year 5—particularly in the areas of system improvements and diversified stakeholder feedback—will enable the team to further its mission success throughout the next period of performance.

Executive Summary

AHRQ launched the Clinical Decision Support (CDS) Connect project in 2016 as part of its CDS initiative to put into practice patient-centered outcomes research (PCOR) findings, with focus on the topics, questions, and outcomes most important to patients and those who care for them. The first 3 years of the project included development and testing of the tools included in the CDS Connect platform. The fourth year of the CDS Connect project1 focused on maintenance and updates to ensure that the tools are shareable, standards-based, publicly available, and patient centered. This annual report documents the project’s accomplishments over the fourth year, organized into four task areas: Task Management, Trust Framework, Standards Conformance, and Outreach.

Task Management (manage project resources)

To meet the needs of the new maintenance and update phase, project leadership changed to provide expertise in program evaluation to support refinement of processes and an increased focus on growth and use.

In addition, new staff with expertise in user experience and engagement joined the CDS Connect project team (hereafter “the team”) to promote the adoption and implementation of CDS Connect’s offerings.

Trust Framework (prioritize activities based on promotion of trust)

To foster trust in CDS Connect, the team engaged with end users and other stakeholders to identify and prioritize updates. The team’s analysis of stakeholder feedback resulted in a framework focused on two primary themes for CDS Connect updates:

1. Validate and update artifacts, as needed, to ensure that they reflect the most recent evidence-based clinical practice.
2. Update artifacts already in the Repository to ensure compliance with applicable health information technology (IT) standards.

Standards Conformance (ensure tools adhere to standards and are innovative)

CDS Connect tools and artifacts are more likely to be used if they adhere to existing, widely accepted standards and include useful innovations for end users. Accordingly, during this period of maintenance and update, the team introduced the following improvements based on the selected themes in Trust Framework task:

1. Implemented a process to review and update, as needed, all CDS artifacts in the CDS Connect Repository.
2. Applied Clinical Practice Guidelines (CPG)-on-Fast Healthcare Interoperability Resources (FHIR®) to the Repository and CDS Authoring Tool to align CDS Connect’s tools and promote ease of implementation in the CDS community.
3. Upgraded software to FHIR Reference 4 (R4) to encourage innovative use.
4. Added a lessons learned series to the Work Group- 130+ CDS community members who provide diverse perspectives and help the team identify and prioritize key features and capabilities for CDS Connect
5. Refreshed the content across the CDS Connect website to accurately reflect the maturity of CDS Connect (e.g., using past tense for completed items as opposed to future tense).
6. Improved accessibility across all CDS Connect resources for persons with disabilities through broader application of standards established to support Section 508 accessibility requirements.

Aided by these improvements, members of the CDS community repurposed the CDS Authoring Tool to develop a prototype drug-drug interaction alerting system and query form while others built on the Factors to Consider in Managing Chronic Pain: A Pain Management Summary artifact.

The improvements to CDS Connect and deeper engagement with its stakeholders have established a foundation for ongoing success.