Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules

Orenstein, Evan; Yun, Katherine; Warden, Clara; Westerhaus, Michael; Mirth, Morgan; Karavite, Dean; Mamo, Blain; Sundar, Kavya; Michel, Jeremy J.

doi:10.1093/jamia/ocz124

Cited by 11 publications

(9 citation statements)

References 27 publications

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“…Published reports indicate time and effort to develop shareable CDS are substantial but have resulted in improved efficiency during implementation at subsequent sites. 12 …”

Section: Discussionmentioning

confidence: 99%

“…Full details of this dissemination effort have been published elsewhere. 12 The second artifact published by this author (The Healthy Weight Care Assistant) relied heavily on custom code and sitespecific functions. It was published as a means to seek feedback and collaboration.…”

Section: Contributor Experience: Case Studiesmentioning

confidence: 99%

“…Published reports indicate time and effort to develop shareable CDS are substantial but have resulted in improved efficiency during implementation at subsequent sites. 12 Overall reduced time depends on the specific materials available in individual artifacts. It is noteworthy that efficiencies only came from the use of mature artifacts with structured and computer-interpretable code.…”

Section: Creating a Business Case For Using Shared Cdsmentioning

confidence: 99%

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To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support

et al. 2020

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Background Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details. Objective Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or “artifacts.” Methods In 2016, the Agency for Healthcare Research and Quality (AHRQ) launched CDS Connect as a public, web-based platform for authoring and sharing CDS knowledge artifacts. Researchers evaluated early use and impact of the platform by collecting user experiences of AHRQ-sponsored and community-led dissemination efforts and through quantitative/qualitative analysis of site metrics. Efforts are ongoing to quantify efficiencies gained by healthcare systems that leverage shared, interoperable CDS artifacts rather than developing similar CDS de novo and in isolation. Results Federal agencies, academic institutions, and others have contributed over 50 entries to CDS Connect for sharing and dissemination. Analysis indicates shareable CDS resources reduce team sizes and the number of tasks and time required to design, develop, and deploy CDS. However, the platform needs further optimization to address sociotechnical challenges. Benefits of sharing include inspiring others to undertake similar CDS projects, identifying external collaborators, and improving CDS artifacts as a result of feedback. Organizations are adapting content available through the platform for continued research, innovation, and local implementations. Conclusion CDS Connect has provided a functional platform where CDS developers are actively sharing their work. CDS sharing may lead to improved implementation efficiency through numerous pathways, and further research is ongoing to quantify efficiencies gained.

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“…Published reports indicate time and effort to develop shareable CDS are substantial but have resulted in improved efficiency during implementation at subsequent sites. 12 …”

Section: Discussionmentioning

confidence: 99%

Section: Contributor Experience: Case Studiesmentioning

confidence: 99%

Section: Creating a Business Case For Using Shared Cdsmentioning

confidence: 99%

See 1 more Smart Citation

To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support

et al. 2020

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“…11 One alternative is for organizations to create shareable, publicly available CDS artifacts. Although numerous barriers exist to using these CDS artifacts, including differences in patient populations, local EHR settings, and unique organizational workflow, 3,[12][13][14] recent advances in standards for data exchange and interoperability 15,16 and public investment in infrastructure 17 have created new opportunities for creation and use of these artifacts. 11,18 CDS artifacts can be described by the degree to which they are executable and interoperable across health settings.…”

Section: Introductionmentioning

confidence: 99%

“…ECRI and the Penn Medicine Center for Evidence-based Practice, which together are an AHRQ EPC member institution, had recently developed a clinical pathway (CP) for Clostridioides (formerly Clostridium) difficile infection (CDI) treatment. 27 We sought to build upon ECRI's expertise in developing shareable CDS from evidence-based recommendations 12,[28][29][30] to develop a systematic and transparent process to translate this CP into structured CDS.…”

Section: Introductionmentioning

confidence: 99%

Translating an evidence-based clinical pathway into shareable CDS: developing a systematic process using publicly available tools

Michel

Flores

Dutcher

et al. 2020

Journal of the American Medical Informatics Association

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Objective To develop a process for translating semi-structured clinical decision support (CDS) into shareable, computer-readable CDS. Materials and Methods We developed a systematic and transparent process using publicly available tools (eGLIA, GEM Cutter, VSAC, and the CDS Authoring Tool) to translate an evidence-based clinical pathway (CP) into a Clinical Quality Language (CQL)-encoded CDS artifact. Results We produced a 4-phase process for translating a CP into a CQL-based CDS artifact. CP content was extracted using GEM into discrete clinical concepts, encoded using standard terminologies into value sets on VSAC, evaluated against workflows using a wireframe, and finally structured as a computer readable CDS artifact using CQL. This process included a quality control step and intermediate products to support transparency and reuse by other CDS developers. Discussion Translating a CP into a shareable, computer-readable CDS artifact was accomplished through a systematic process. Our process identified areas of ambiguity and gaps in the CP, which generated improvements in the CP. Collaboration with clinical subject experts and the CP development team was essential for translation. Publicly available tools were sufficient to support most translation steps, but expression of certain complex concepts required manual encoding. Conclusion Standardized development of CDS from a CP is feasible using a systematic 4-phase process. CPs represent a potential reservoir for developers of evidence-based CDS. Aspects of CP development simplified portions of the CDS translation process. Publicly available tools can facilitate CDS development; however, enhanced tool features are needed to model complex CDS statements.

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The role of organizational culture in health information technology implementations: A scoping review

Rajamani

Hultman

Bakker

et al. 2021

Learning Health Systems

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Introduction The exponential growth in health information technology (HIT) presents an immense opportunity for facilitating the data‐to‐knowledge‐to‐performance loop which supports learning health systems. This scoping review addresses the gap in knowledge around HIT implementation contextual factors such as organizational culture and provides a current state assessment. Methods A search of 13 databases guided by Arskey and O'Malley's framework identified content on HIT implementations and organizational culture. The Consolidated Framework for Implementation Research (CFIR) was used to assess culture and to develop review criteria. Culture stress, culture effort, implementation climate, learning climate, readiness for implementation, leadership engagement, and available resources were the constructs examined. Rayyan and Qualtrics were used for screening and data extraction. Results Fifty two studies included were mainly conducted in Academic Health Centers (n = 18, 35%) and at urban locations (n = 50, 96%). Interviews frequently used for data collection (n = 26, 50%) and guided by multiple frameworks (n = 34). Studies mostly focused on EHR implementations (n = 23, 44%) followed by clinical decision support (n = 9, 17%). About two‐thirds (n = 34, 65%) reflected culture stress theme and 62% (21 of 34) acknowledged it as a barrier. Culture effort identified in 27 studies and was a facilitator in most (78%, 21 of 27). Leadership engagement theme in majority studies (71%, n = 37), with 35% (n = 13) noting it as a facilitator. Eighty percent (42 studies) noted available resources, 12 of which identified this as barrier to successful implementation. Conclusions It is vital to determine the culture and other CFIR inner setting constructs that are significant to HIT implementation as facilitators or barriers. This scoping review presents a limited number of empirical studies in this topic highlighting the need for additional research to quantify the effects of culture. This will help build evidence and best practices that facilitate HIT implementations and hence serve as a platform to support robust learning health systems.

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Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules

Cited by 11 publications

References 27 publications

To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support

To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support

Translating an evidence-based clinical pathway into shareable CDS: developing a systematic process using publicly available tools

The role of organizational culture in health information technology implementations: A scoping review

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