Quantifying System and Data Readiness for Automated Clinical Decision Support

摘要 自动化临床决策支持(CDS)工具(例如，提供商警报和提醒或上下文相关 治疗信息)，嵌入到电子健康记录(EHR)系统中，已经被证明是改进的 供应商遵守实践指南，并改善患者的预后。自动化的常规使用 CDS是美国疾病控制与预防中心认可的国家医疗改革战略的基本组成部分 医疗保险和医疗补助服务，国家卫生信息技术协调员办公室，以及两位总统。 一旦一个组织确定了临床上的“实践差距”和相应的CDS应用程序，例如提供商 警示，必须解决一些技术和社会问题，以确保CDS干预很好地适应 在当前的工作流程中，供应商可以接受，并按预期运行。*目前，没有关于 潜在的CDS实施者关于如何使他们的本地数据结构与患者数据“输入”保持一致 正式的基于算法的指南的要求，也没有一个模型来量化 将不同的CDS应用程序集成到本地EHR中所需的组织或资源 系统。这项拟议的研究将量化CDS数据需求(“输入”)与EHR的一致性 数据结构、收集的数据的质量以及提供商的首选项。我们建议将这些组合在一起 将指标纳入CDS实施的可行性评估，组织可以使用这些指标来确定优先顺序 CDS项目以及疾病倡导组织和专业协会为确定CDS机会而开展的活动 具有最广泛的实施和影响潜力。

ABSTRACT Automated clinical decision support (CDS) tools (e.g., provider alerts and reminders, or context relevant treatment information), embedded within electronic health record (EHR) systems, have been shown to improve provider compliance with practice guidelines and improve patient outcomes. The routine use of automated CDS is a fundamental component of the national healthcare reform strategy endorsed by the Centers for Medicare and Medicaid Services, the Office of the National Coordinator for Health IT, and two presidents. Once an organization identifies a clinical “practice gap” and corresponding CDS application, such as a provider alert, a number of technical and social issues must be addressed to ensure that the CDS intervention fits well in current work flows, is acceptable to providers, and functions as intended. At present, there is no guidance for potential CDS implementers on how to align their local data structures with the patient data “input” requirements of formal algorithm-based guidelines, nor is there a model to quantify the readiness of an organization or the resources that will be needed to integrate different CDS applications into local EHR systems. This proposed research will quantify the alignment of CDS data requirements (“inputs”) with EHR data structures, the quality of the data collected, and provider preferences. We propose to combine these metrics into a feasibility assessment for CDS implementation that can be used by organizations to prioritize CDS projects and by disease advocacy organizations and professional societies to identify CDS opportunities with the broadest potential for implementation and impact.