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

Abstract

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.

Celebrating Clinical Informatics as a Specialty Practice

“…Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support," describes how the use of the Agency for Healthcare Research & Quality's CDS-Connect can provide a platform for peer-to-peer sharing of CDS tools. 10 The United States is among the global leaders in the implementation of electronic health records (EHRs) and HIT 11,12 ; however, the U.S. health care system lags behind comparable countries in most health care measures despite spending comparatively more per person. For example, in 2018, while the U.S. spent $10,586 on health care per capita (more than twice of Canada), 13 its life expectancy was 78.54 years, lower than Canada's 82.47 years.…”

The Evolution of Clinical Knowledge During COVID-19: Towards a Global Learning Health System

“…This Collaborative emphasises development of digital infrastructure to support the Knowledge Ecosystem, a cycle of Action-Data-Evidence-Guidance that mirrors the LHS cycle. It has further been active in developing groups such as COKA, the COVID-19 Knowledge Accelerator Initiative 14 [74], a response focused on COVID-19 to the call by Dunn and Bourgeois [73] to aim for computable knowledge synthesis and representation, through the use of standards such as EBMonFHIR 15 [79] and CPGonFHIR 16 , or rule formalisms for computational clinical guideline specification [80].…”

“…Translation of new knowledge into practice (Q3) required evidence synthesis approaches such as systematic reviews, critically involving searching (information retrieval), screening, appraisal, and meta-analysis of research publications. Key conclusions were rapidly shared via actively maintained, living guidelines [ 15 ] and platforms [ 16 ] or tools [ 17 ] for making available clinical decision support knowledge artifacts.…”

Algorithmic Detection of Boolean Logic Errors in Clinical Decision Support Statements

“…27 These algorithms could also be implemented in EHR-agnostic authoring tools, such as CDS Connect. 28 It is intriguing that all sites had demonstrable errors, yet none were aware of them. In our previous work on CDS anomalies, we learned that clinicians may not be aware of such errors 6 and showed that many types of build and conceptualization errors were common.…”