A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties

BMC Medical Informatics and Decision Making

Correspondence

Justin W Timbie¹  Eric C Schneider²  Cheryl L Damberg³  Douglas S Bell³ 

[1] RAND Corporation, 1200 South Hayes Street, 22202, Arlington, VA, USA;Rand Corporation, 20 Park Plaza, 9th Floor, Suite 920, 02116, Boston, MA, USA;Rand Corporation, P.O. Box 2138, 1776 Main Street, 90407, Santa Monica, CA, USA;

关键词: Electronic Health Record;    Clinical Decision Support;    Interventional Cardiology;    Clinical Decision Support Tool;    North American Spine Society;   

DOI  :  10.1186/1472-6947-12-93

 received in 2012-01-25, accepted in 2012-08-21,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as “CDS opportunities,” might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists’ clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics.

【 授权许可】

CC BY   
© Timbie et al.; licensee BioMed Central Ltd. 2012