The federal electronic health record (EHR) incentive program includes clinical decision support (CDS) as a central requirement of improving health outcomes; however, a process for identifying and prioritizing the most promising targets for CDS has not been established. CDS provides those involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. This report describes a protocol for eliciting high-priority targets for electronic CDS for individual clinical specialties, which could serve to inform policymakers' deliberations and establishment of CDS meaningful use objectives. Researchers from the RAND Corporation tested the protocol with four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics. A CDS target was defined as a clinical performance gap having one or more CDS opportunities that can be implemented to address the gap. A CDS opportunity is defined as a specific CDS intervention that could be expected to address a clinical performance gap. CDS opportunities include existing CDS tools or interventions that might be developed in the short term. Identification of candidate performance gaps and CDS opportunities was based on a review of the literature and expert clinical input from the members of each of the four clinical specialty panels. High-priority CDS targets were the performance gaps that the panels rated as highly important and as having one or more CDS opportunities that could have a high impact on closing the performance gap and were considered compatible with clinical workflow. This report summarizes lessons learned from testing the protocol.
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