Clinical Decision

Support
S pp Consortium
C
Blackford Middleton, MD, MPH, MSc
L
Lana T
Tsurikova,
ik MS
MSc, MA
Adam Wright, PhD
Dean F. Sittig,
g, PhD
Brigham & Womens Hospital
Partners Healthcare, University of Texas, Houston
 CDS Demonstration Projects
_______________________________________________

Objective
j
To develop, implement, and evaluate projects that
advance the understanding of how best to incorporate
CDS into health care delivery.
y
Overall goal
Explore how the translation of clinical knowledge into
CDS can be routinized in practice and taken to scale in
order to improve the quality of healthcare delivery in the
U.S.
Funding
$1.25 million per project per year for two years
Other Key
y Demonstration Goals
_______________________________________________
Incorporate CDS into EHRs certified by the Certification
C
Commission
i i ffor HHealth
lth IT (CCHIT)
(CCHIT).
Demonstrate cross-platform utility.
Establish lessons learned for CDS implementation
across the health IT vendor community.
Assess potential benefits and drawbacks of CDS.
Evaluate methods for creating, storing, and replicating
CDS elements across multiple clinical sites and
ambulatory practices.
Translate clinical guidelines and outcomes related to
preventive health care and treatment of patients with
chronic illnesses.
CDS Consortium:
Member Institutions
Partners
P t HealthCare
H lthC
Regenstrief Institute
V t
Veterans Health
H lth AdAdministration
i i t ti
Kaiser Permanente
Siemens Medical Solutions/NextGen
GE Healthcare
Oregon Health and Science University
University of Texas, Houston
K R
Key Research
hQQuestions
ti
How do we improve the translation of knowledge in clinical practice guidelines
i t actionable
into ti bl CDS iin h
healthcare
lth iinformation
f ti ttechnology?
h l ?
How do we optimally represent knowledge and data required to make
actionable CDS content in both human and machine readable form?
How do we collate,
collate aggregate
aggregate, and curate knowledge content for CDS in a
knowledge portal used by members of the CDS Consortium? How may we use
such a tool to support knowledge management and collaborative knowledge
engineering for clinical decision support at scale, across multiple healthcare
delivery organizations, and multiple domains of medicine?
How do we demonstrate broad adoption of evidence-based CDS at scale in a
wide array of HIT products used in disparate ambulatory care delivery settings?
Further, how do we deploy clinical decision support services in healthcare
information technology
gy in a manner that improves
p CDS impact?
p
How do we take the learnings garnered through the course of these
investigations and broadly disseminate them broadly to key stakeholders?
Si S
Six Specific
ifi RResearch
h Obj
Objectives
ti
Knowledge management lifecycle
Knowledge specification
Knowledge Portal and Repository
CDS Knowledge Content and Public Web Services
Evaluation
Dissemination

1. Knowledge Management Life Cycle

2. Knowledge 3. Knowledge Portal and 4. CDS Public Services
Specification Repository and Dashboard
5 Evaluation Process for each CDS Assessment and Research Area
5.
6. Dissemination Process for each Assessment and Research Area
 Complete CDS Knowledge
Specification
Data Logic Function Measure

Narrative

Semi-
structured
A complete functional specification
Abstract to accommodate and facilitate a
variety of implementation methods in HIT.
Machine
interpretable
 Goals of the GLIDES Project
1. Implement evidence-based guideline
recommendations that address prevention of pediatric
obesity and chronic management of asthma
2. Apply GEM and its associated tools to systematically
and replicably
p y transform the knowledge g contained
in these guidelines into a computable format
3. Deliver the knowledge via electronic decision
support at ambulatory sites that employ Centricity
EMR at Yale and EpicCare at Nemours
4. Evaluate the fulfillment of these goals and the
effectiveness of the decision support tools in improving
the quality of health care
5. Disseminate the findings and lessons learned

9
 GEM

Knowledge model for guideline documents

Multi-level
Multi level hierarchy (>100 elements)
Parses heterogeneous information contained in
g
guidelines
Facilitates translation of guidelines into a format that
can be processed by computers
GEM
G DTD adopted as ANSI S standard (ASTM
( S E2210-02))
GEM II Schema adopted as ANSI standard (E2210-06)
Identify Clinical Objectives
Select Guideline
COGS, AGREE
COGS
Narrative Guideline GLIA

GEM Cutter
C tt Markup
M k

XML file
Semi-structured Quality & Implementability Appraisals

EXTRACTOR Transforms
Statement
St t t logic
l i
Semi-formal Coded decision variables & actions
Action-types

Local workflow / barrier analysis (technical, people,

organizational); local codes; origins/insertions; CDS modality

Formal Local EHR scripting language, UI