CDS Connect: A Patient-Centered CDS Authoring Tool and Rules Library

CDS Connect: A Patient-Centered CDS Authoring Tool and Rules Library July 20, 2017 Moderator: Blackford Middleton, MD, MPH, MSc Chief Informatics & Innovation Officer, Apervita, Inc. Co-chair, Learning Network Steering Committee www.pcorcds-ln.org

What is Patient-Centered CDS? Working Learning Network definition: CDS that supports individual patients and their care givers/care teams in health-related decisions and actions by leveraging information from clinical evidence and patient-specific information (e.g. patientgenerated data).

PCCDS Learning Network What: AHRQ funded cooperative agreement through 2020 Mission: create multi-stakeholder Learning Network that catalyzes improved care and outcomes through effective use of patient-centered clinical decision support Strategy: Inform Connect Advance Who: Over 200 members from different constituencies Become a member: https://pcorcds-ln.org/user/register 3

Learning Network Programs September Webinar Scaling CDS for Disseminating Guidelines in Public Health: A Case Example Thursday September 14th from 1-2pm EST Jim Jellison, MPH; Director, Practice Support at Public Health Informatics Institute Blackford Middleton, MD, MPH, MSc; Chief Informatics & Innovation Officer, Apervita, Inc. https://pcorcds-ln.org/webinars 4

Patient-Centered CDS Learning Network Annual Meeting Invitations by e-mail are forthcoming 5

Share comments and ask questions Raise your hand to be unmuted or Tweet @pccdsln or type a question 6

Internal Distribution Only Not for Public Release Jul 20, 2017

Mission: Demonstrate a system that identifies new evidence-based standards of care, codifies the artifacts in an international standard, and shares the resulting Clinical Decision Support (CDS) capabilities Activities: 1. Design and build an online software repository for hosting and sharing new CDS artifacts 2. Identify and codify new CDS artifacts for care, initially in the domain of cholesterol management 3. Pilot CDS artifacts in a live, clinical workflow environment 4. Convene external discussions focused on accelerating evidence into practice through CDS Sponsor: Agency for Healthcare Research and Quality Internal Distribution Only Not for Public Release 8

What is Clinical Decision Support (CDS)? Process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve healthcare outcomes and healthcare delivery CDS involves delivering: 1. the right information 2. to the right person 3. in the right format 4. through the right channel 5. at the right time Internal Distribution Only Not for Public Release 9

Types of Clinical Decision Support Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 10

Types of Clinical Decision Support https://cds.ahrq.gov/ Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 11

Types of Clinical Decision Support https://cds.ahrq.gov/ Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 12

Types of Clinical Decision Support https://cds.ahrq.gov/ Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 13

Types of Clinical Decision Support https://cds.ahrq.gov/ Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 14

Types of Clinical Decision Support https://cds.ahrq.gov/ Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 15

Types of Clinical Decision Support https://cds.ahrq.gov/ Alerts Medication alerts Clinical practice alerts Duplicate alerts Contextual Reminders Order sets Risk assessments Questionnaires Reference information Reports Internal Distribution Only Not for Public Release 16

CDS Repository - Concept of Operations Internal Distribution Only Not for Public Release 17

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CDS Artifact Development Identify and develop new CDS artifacts for initial content of the CDS Connect repository Drives the software requirements Initial CDS development focused in the domain of cholesterol management Clinical domain was identified as the best opportunity to improve quality of care, access to care, and contain the cost Cholesterol management is also a lightning rod for disagreements on the best clinical guidelines to improve the outcomes of patients Internal Distribution Only Not for Public Release 21

American College of Cardiology (ACC) and American Heart Association (AHA) Baseline Risk Model Binomial inputs Current smoker (yes/no) Diabetes (yes/no) Treated for high blood pressure (yes/no) Multinomial inputs Age (years) Total cholesterol (mg/dl) HDL cholesterol (mg/dl) Systolic blood pressure (mm Hg) Four variations of the model exist to account for Male / Female and White / African American dependencies Internal Distribution Only Not for Public Release 22

ACC/AHA 10 Year Risk Model in Two Dimensions Internal Distribution Only Not for Public Release 23

Work Group Engagements Coordination, Planning, and Execution MITRE AHRQ Integration Tools & Pilots CDS Prototype Development and Dissemination Work Groups Cholesterol Management Guidance & Feedback CDS SMEs Cholestorol SMEs MITRE CDS Repository CDS SMEs Healthcare Providers EHR Vendors Internal Distribution Only Not for Public Release

Work Group Engagements Internal Distribution Only Not for Public Release

Live and Operational CDS Artifact Pilot Pilot activity of the newly created cholesterol management CDS artifacts in a live/operational clinical setting Benefits: Ensures that the CDS artifacts perform as expected Experience will be used to refine the CDS artifacts and inform the CDS Repository Evaluates the efficacy of the CDS artifacts and development process Internal Distribution Only Not for Public Release 26

Live and Operational CDS Artifact Pilot Internal Distribution Only Not for Public Release 27

Project Timeline Internal Distribution Only Not for Public Release 19

Questions? Internal Distribution Only Not for Public Release 29

30 Questions and Discussion

Share comments and ask questions Raise your hand to be unmuted Or type a question 31

Learning Network Programs September Webinar Scaling CDS for Disseminating Guidelines in Public Health: A Case Example Thursday September 14th from 1-2pm EST Jim Jellison, MPH; Director, Practice Support at Public Health Informatics Institute Blackford Middleton, MD, MPH, MSc; Chief Informatics & Innovation Officer, Apervita, Inc. https://pcorcds-ln.org/webinars 32

Thank you! http://www.pcorcds-ln.org 33