Developing a Framework for Establishing Clinical Decision Support Meaningful Use Objectives for Clinical Specialties

by Cheryl L. Damberg, Justin W. Timbie, Douglas S. Bell, Liisa Hiatt, Amber Smith, Eric C. Schneider

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Abstract

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.

Table of Contents

  • Chapter One

    Methodology for Eliciting High-Priority Clinical Decision Support Targets

  • Chapter Two

    Oncology Results

  • Chapter Three

    Orthopedics Results

  • Chapter Four

    Pediatrics Results

  • Chapter Five

    Percutaneous Coronary Intervention Panel Results

  • Chapter Six

    Discussion and Recommendations

  • Appendix A

    Oncology Panel Materials

  • Appendix B

    Orthopedics Panel Materials

  • Appendix C

    Pediatrics Panel Materials

  • Appendix D

    Percutaneous Coronary Intervention Panelist Materials

Research conducted by

The research described in this report was sponsored by the U.S. Department of Health and Human Services and was conducted in RAND Health, a division of the RAND Corporation.

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