AHRQ Turns to Patient-Facing Use Case for CDS Connect

Feb. 28, 2019
Effort continues to create platform for shareable clinical decision support artifacts

The Agency for Healthcare Research and Quality (AHRQ)’s CDS Connect project continues to make progress on creating a library of shareable clinical decision support artifacts. In 2018 its efforts were focused on creating a SMART on FHIR app to help clinicians address the opioid crisis and pain management. In 2019 it is working with patient-facing platform Bwell on U.S. Preventive Services Task Force recommendations to reduce the prevalence of avoidable chronic disease.

During a Feb. 27 webinar, Edwin Lomotan, M.D., medical officer and chief of clinical informatics for the Health IT Division in AHRQ’s Center for Evidence and Practice Improvement, gave an update on CDS Connect’s progress and encouraged more provider organizations and EHR vendors to participate in creating and using shared CDS artifacts. (AHRQ awarded the MITRE Corp. a contract to develop CDS Connect and develop and share CDS artifacts on CDS Connect.)

Lomotan described how CDS Connect is building and managing a web-based platform for sharing CDS. It also is developing open-source software for building CDS using the Clinical Quality Language (CQL) standard, the same standard being used to develop electronic clinical quality measures. He explained that CDS artifacts are items that represent medical knowledge from various sources such as clinical guidelines. The artifacts can take many forms, but the ultimate goal is to create computable, interoperable translations using CQL.

“Our goal is to make available building blocks of decision support,” Lomotan said. The hope is that the next person in need of a similar type of CDS does not have to start from scratch, because not every organization has resources to do that.” He noted that CDS can take on a negative connotation of annoying popup alerts for physicians, but taking a broader view, they are more of a process than an app or widget.  “They are an enabler and tool for quality improvement. There are many ways to provide clinical decision support and not all have to be at point of care. It can be seen as the actionable side of quality measurement.”

He said CDS Connect contributions have come from CDC, ONC, and the VA as well as from academic institutions, researchers and others.

The 2018 use case focusing on opioids and pain management summary worked with Portland, Ore.-based OCHIN, which provides EHR hosting and other data services to community-based clinics. The CDS was informed by 2016 CDC guideline about prescribing opioids for chronic pain and it consolidates patient-specific information normally found on different tabs and screens in EHR into a single view. It uses the SMART on FHIR health IT standard for interoperability. Health systems can try it out: https://apps.smarthealthit.org/app/cds-connect

AHRQ also has funded a year-long study by Medstar to attempt to quantify potential efficiencies gained through shareable, interoperable CDS resources such as those available through CDS Connect.

Lomotan encouraged interested parties to join the CDS Connect work group. “People from all types of organizations help to inform what we build and what we should do next,” he said. People could also join the Patient-Centered CDS Learning Network, which is forming work groups for 2019.

“If you have CDS that might be appropriate, consider contributing to the repository,” he said. Or become a CDS Connect consumer. Go to the repository, download the artifacts and open source tools, get into the weeds and provide feedback.”

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