The Learning Health System Series
Optimizing Strategies for
CLINICAL
DECISION
SUPPORT
Summary of a Meeting Series
James E. Tcheng; Suzanne Bakken; David W. Bates; Hugh Bonner III; Tejal K. Gandhi; Meredith Josephs; Kensaku Kawamoto; Edwin A. Lomotan; Erin Mackay; Blackford Middleton; Jonathan M. Teich; Scott Weingarten; Marianne Hamilton Lopez, Editors
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NOTICE: This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a useful contribution worthy of public attention, but does not represent formal endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors’ organizations.
Support for this publication was provided by the Office of the National Coordinator for Health Information Technology.
Library of Congress Cataloging-in-Publication Data
Names: Tcheng, James E., editor. | National Academy of Medicine (U.S.), issuing body. | Optimizing Strategies for Clinical Decision Support (Meeting) (2016-2017 : Washington, D.C.)
Title: Optimizing strategies for clinical decision support : summary of a meeting series / James E. Tcheng [and 12 others], editors.
Description: Washington, DC : National Academy of Medicine, [2017] | Series: The learning health system series | Includes bibliographical references. | Identifiers: LCCN 2017055006 (print) | LCCN 2017056753 (ebook) | ISBN 9781947103092 (Ebook) | ISBN 9781947103085 (pbk.) |
Subjects: | MESH: Decision Support Systems, Clinical | Clinical Decision-Making | Medical Informatics | Congresses
Classification: LCC R858 (ebook) | LCC R858 (print) | NLM W 26.55.D2 | DDC 610.285--dc23
LC record available at https://lccn.loc.gov/2017055006
Copyright 2017 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Suggested citation: Tcheng, J. E., S. Bakken, D. W. Bates, H. Bonner III, T. K. Gandhi, M. Josephs, K. Kawamoto, E. A. Lomotan, E. Mackay, B. Middleton, J. M. Teich, S. Weingarten, and M. Hamilton Lopez, editors. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: National Academy of Medicine.
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STEERING COMMITTEE
JAMES E. TCHENG, MD, FACC, FSCAI, FSEC, Duke University School of Medicine (Chair)
SUZANNE BAKKEN, PhD, RN, FAAN, FACMI, Columbia University
EDWIN A. LOMOTAN, MD, FAAP, Agency for Healthcare Research and Quality
DAVID W. BATES, MD, MSc, Brigham and Women’s Hospital
ERIN MACKAY, MPH, National Partnership for Women & Families
HUGH BONNER III, MD, Saint Francis Healthcare
TEJAL K. GANDHI, MD, MPH, CPPS, National Patient Safety Foundation
JONATHAN TEICH, MD, PhD, Brigham and Women’s Hospital, Harvard University
MEREDITH JOSEPHS, MD, MPH, FAAFP, Privia Health
SCOTT WEINGARTEN, MD, MPH, Cedars-Sinai Health System
NAM Staff
Development of this publication was facilitated by contributions of the following NAM staff, under the guidance of Michael McGinnis, MD, MPP, NAM Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System:
MARIANNE HAMILTON LOPEZ, PhD, MPA, Senior Program Officer and Project Director
MICHELLE JOHNSTON-FLEECE, MPH, Senior Program Officer
VANANH VO, Senior Program Assistant, after November 2016
ROSHEEN BIRDIE, Senior Program Assistant, until September 2016
LAURA DeSTEFANO, Director of Communications
KYRA E. CAPPELUCCI, Communications Specialist
MOLLY DOYLE, Communications Specialist
Consultant
JOE ALPER, rapporteur
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REVIEWERS
This special publication was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine. We wish to thank the following individuals for their review of this publication:
ANDREW BAZEMORE, MD, MPH, Robert Graham Center, American Academy of Family Physicians
JONATHAN B. PERLIN, MD, PhD, MSHA, MACP, FACMI, HCA (Hospital Corporation of America)
ADAM WRIGHT, PhD, FACMI, Harvard Medical School and Brigham and Women’s Hospital
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the publication, nor did they see the final draft before it was published. Review of this publication was overseen by Marianne Hamilton Lopez, PhD, MPA, Senior Program Officer, NAM; and Michael McGinnis, MD, MPP, Leonard D. Schaeffer Executive Officer, NAM. Responsibility for the final content of this publication rests entirely with the editors and the NAM.
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ACKNOWLEDGMENTS
We would like to thank Daniel Bearss with the National Academies of Sciences, Engineering, and Medicine for contributing to the development of this publication through fact-checking assistance.
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CONTENTS
Challenges to Clinical Decision Making
Clinical Decision Support Concepts
NAM-ONC Project on CDS Strategies
2 Laying the CDS Foundation Stones
A Roadmap for National Action on CDS
Structuring Care Recommendations for CDS
3 Priorities for Accelerating CDS Progress
Creating, Managing, and Curating Content
Learning from CDS Implementation
Practical Strategies for Embedding CDS
Explicating the CDS Value Proposition
4 Agenda for CDS Adoption and Use
Develop, Test, Establish, Validate, and Apply Standards
Encourage Delivery System Adoption, Use, and Assessment
ACRONYMS AND ABBREVIATIONS
| AFA | Analytic Framework for Action |
| AHRQ | Agency for Healthcare Research and Quality |
| AMIA | American Medical Informatics Association |
| API | application program interface |
| APMs | alternative payment models |
| CDS | clinical decision support |
| CDSC | Clinical Decision Support Consortium |
| CHIME | College of Healthcare Information Management Executives |
| CMS | Centers for Medicare and Medicaid Services |
| CPG | clinical practice guidelines |
| EHR | electronic health record |
| FDA | U.S. Food and Drug Administration |
| FHIR | Fast Healthcare Interoperability Resources |
| HFMA | Healthcare Financial Management Association |
| HHS | Department of Health and Human Services |
| HIMSS | Healthcare Information and Management Systems Society |
| HITECH | Health Information Technology for Economic and Clinical Health Act |
| HL7 | Health Level Seven international standards |
| ICER | Institute for Clinical and Economic Review |
| IHI | Institute for Healthcare Improvement |
| IOM | Institute of Medicine |
| ISMP | Institute for Safe Medication Practices |
| IT | information technology |
| MACRA | Medicare Access and CHIP Reauthorization Act |
| MRI | magnetic resonance imaging |
| NAM | National Academy of Medicine |
| NASEM | The National Academies of Sciences, Engineering, and Medicine |
| NCQA | The National Committee for Quality Assurance |
| NQF | National Quality Forum |
| ONC | Office of the National Coordinator for Health Information Technology |
| PCOR | patient-centered outcomes research |
| PCORI | Patient-Centered Outcomes Research Institute |
| PSOs | patient safety organizations |
