CDS Connect: Frequently Asked Questions

Frequently Asked Questions

Who can use CDS Connect?

Anybody! CDS Connect is freely available for anyone to use. Generally, the following populations will find CDS Connect valuable:

  • Clinicians
  • Clinical Informaticists
  • CQL developers
  • Health IT Vendors

 

What is a CDS artifact?

CDS artifacts are items that represent medical knowledge from various knowledge sources (e.g. clinical guidelines, peer-reviewed articles, local best practices, and Clinical Quality Measures). The artifacts can take many forms, but the goal is to create computable, interoperable translations using CQL. For more information, see knowledge levels discussion (Boxwala et al. JAMIA vol. 18 Suppl 1, 2011).

 

What is CQL?

CQL is a data standard governed by  Health Level Seven (HL7)  that is currently a Standard for Trial Use (STU). CQL expresses logic in a human-readable document that is also structured enough for electronic processing of a query. It can be used within both the Clinical Decision Support (CDS) and  Clinical Quality Measurement (CQM) domains .

For more information, see the eCQI Resource Center.

 

How do I find artifacts that are relevant to my organization?

As of August 2020, there are currently 62 CDS artifacts. The artifacts in the Repository span a number of clinical domains including cardiovascular disease, preventive care, chronic pain management, etc. and are contributed by a variety of organizations, including other Federal agencies.

You can search for artifacts by type, description, keyword, title, topic, and publisher, as well as filter the artifacts by topic area.

For more information, visit the Repository.

 

How can I contribute CDS artifacts to the Repository?

The process entails coordinating with the CDS Connect project team on expected data and formats, setting up author credentials, submitting the material for MITRE review, working through any feedback, and then publishing the content.

Once you have author credentials, you can find documentation on how to use the accounts in the July 2018 work group slides: https://cds.ahrq.gov/sites/default/files/workgroups/671/july-2018-cds-connect-wg-ppt.pdf

We look forward to hearing from you! To begin the process, please contact us.

 

Why does CDS Connect exist?

CDS Connect is a project funded by the Agency for Healthcare Research and Quality to advance evidence into clinical practice through CDS and to make CDS more shareable, standards-based, and publicly-available.

For more information, visit the About page.

 

If I upload artifacts to CDS Connect, does the copyright status of those artifacts change?

Copyright and stewardship of CDS artifacts original to CDS Connect (i.e., developed in coordination with AHRQ and MITRE's Health FFRDC) is being managed on a case-by-case basis with AHRQ.

Third party contributors of CDS artifacts to the Repository are required to provide an attestation of their authority to distribute the artifact, which does not change the copyright status of the work.  Depending on the use of the contribution, CDS Connect may request additional permissions from the contributor. 

For more information about copyright considerations, please contact us.

 

How can I assert my copyright?

In the event that you are the owner of the copyright in any of the material on this website and do not consent to the use of your material in accordance with the terms and conditions of use of this website, please contact us providing the information requested in the form and we will withdraw your material from our website within five working days of receipt of your written objection and proof of ownership of the aforementioned material.

In order to process your request, please provide all information required in the form. Note that to be effective under applicable law, your notification of claimed infringement must be a written communication provided to the designated agent of CDS Connect that includes substantially all the information requested in the form.

When completed and submitted your form will be sent to the to the CDS Connect Designated Agent, also reachable at the following address: ClinicalDecisionSupport@ahrq.hhs.gov

It is strongly recommended that you submit your information using the form, which will be delivered to the email address above. 

Your request will be acknowledged within five working days of receipt.

 

How do I maintain my contributed CDS artifacts?

First, you will need to determine if your artifact is expected to undergo content review and update; not all artifacts do. You can determine the content review and update expectation based on the Experimental and Status metadata associated with your CDS artifact, and using the metadata responses to review the table below.  Please contact us if you are unsure which responses apply to your artifact.

Regardless of what you determine about your artifact by reviewing the table, any associated documentation (i.e., human-readable, downloadable files) posted with your artifact must meet Section 508 accessibility requirements.  In other words, at the minimum, your artifact documents will need to be accessible to be considered properly maintained.

 

Artifact Metadata Field

Response Selected

Content Review & Update Expectation
Experimental1      Yes No expectation for review and update.
  No

Expectation for review and update determined by response to ‘Status’ metadata field.

Status2     Draft

No expectation for review and update.

  Active

Annual review and update is expected.  Follow the four steps outlined below.

Note: Artifacts will denote a temporary ‘Draft’ status while your update is in process.

  Retired

No expectation for review and update.

Note: 'Retired' artifacts have the option to invite members of the CDS Community to continue development of the CDS artifact.

 

Unknown

Review and update process may be expected, based on if intent is to move artifact to  'Active' Status.

1Experimental – Is ‘Yes’ if this artifact is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage in a clinical setting.

2Status – Can be ‘Draft’ (under development, not ready for normal use), ‘Active’ (ready for normal use), ‘Retired’ (withdrawn or superseded, no longer of use), or ‘Unknown’ (status unclear).

Again, please contact us if you are unsure which responses apply to your artifact.  We'd be happy to help you decide.

 

Based on the review and update expectations determined by the table above, when applicable, proceed with applying the following four step review to your artifact.

Step 1: Is the evidence behind the CDS artifact still current? 

  • Determine whether the primary source of evidence (e.g., the United States Preventative Services Task Force (USPSTF) recommendation) has been updated since the artifact was developed. 

    • If so, perform a detailed analysis of the new evidence and determine where it aligns and where it diverges from the existing evidence. Identify all aspects of the artifact that need to be updated and perform the updates.  Examples of updates include clinical definitions [standardized codes, value sets], L2 and L3 logic [operators, lookback periods, logic phrases], decision points [which ripples into updating the decision log], and documentation.)

      • Ensure you consult the decision log during this analysis, as sometimes decisions that appear contrary to evidence have an educated rationale.  

      • This effort often takes collaboration between the clinical informaticist, clinical subject matter experts, CQL developers, and guideline authors (if available). It may also ripple over into potential updates to associated integration code, apps, etc.

    • If not, determine if the guideline authors are in the process of updating the guideline. In that case, incorporate the timeline. It can be added to the metadata, so viewers understand that the artifact may need to be updated in the near-term.

Step 2: Are the metadata still current? 

  • Review and update existing metadata (e.g., Has anything become outdated?  Any spelling errors or typos?  Any broken hyperlinks?  Anything that can be made clearer or enhanced?) 

  • Update metadata fields, as indicated, if new evidence has been published by the guideline author. This may inform the addition of a new entry in the Caution (and other) section(s). 

  • Other considerations that can prompt updating the metadata: 

    • Will you be retaining the originally posted version, along with posting a new version?  

      • If so, consider adding information in the metadata to clearly explain why more than one version of the artifact or code is available. There is value in maintaining the original version of an artifact if it was piloted because of the implementation guidance and lessons learned that can be shared.  

      • If not, update the metadata before swapping out the old version.

Step 3: Are the value sets (VSs) still current?

  • Determine if any new VSs or codes have been published that define a clinical concept in the logic and if one or more is a better fit for the CDS artifact. 

    • If so, that object identifier (OID) should replace the existing OID and be updated in the Clinical Quality Language (CQL), which may impact the metadata, the decision log, data requirement form, documentation, etc. 

      • Ensure that the decision log is consulted during this analysis, as sometimes decisions that appear contrary to evidence have an educated rationale.  

      • Coordinate with CQL subject matter experts (SMEs) to perform the update and publish a new version of CQL code.

  • Determine if any Publishing Organization-created VSs were used in the artifact.

    • If so, VSs will need to be updated by reviewing all the terminologies within each VS to see if any new codes have been released that are appropriate for inclusion in the VS.

Step 4: Do supporting documents need updates? 

  • Based on all that has been learned during the artifact update process and all the work that was performed to update the artifact, determine whether documentation updates are required. 

    • If so, edit the documentation as indicated, including ensuring Section 508 accessibility requirements are met. Documentation will be checked by the Governor for accessibility, with any remediation feedback provided to the Publishing Organization Lead. The Governing Organization will ultimately approve the Section 508 accessibility of the documents. 

    • Include a Change Log to clearly describe what has changed between the two versions.

This review process is dynamic and influenced by best practices, lessons learned, and feedback from the CDS Community—contact us to share your feedback. 

 

How can I get help?

Contact us with with specific questions or consider joining the CDS Connect Work Group to continuously learn and engage with CDS Connect.