Abstract
Background Clinical decision support (CDS), which provides tools to assist clinical decision-making,
can improve adherence to evidence-based practices, prevent medical errors, and support
high-quality and patient-centered care delivery. Publicly available CDS that uses
standards to express clinical logic (i.e., standards-based CDS) has the potential
to reduce duplicative efforts of translating the same clinical evidence into CDS across
multiple health care institutions. Yet development of such CDS is relatively new and
its potential only partially explored.
Objectives This study aimed to describe lessons learned from a national initiative promoting
publicly available, standards-based CDS resources, discuss challenges, and report
suggestions for improvement.
Methods Findings were drawn from an evaluation of the Agency for Healthcare Research and
Quality Patient-Centered Outcomes Research CDS Initiative, which aimed to advance
evidence into practice through standards-based and publicly available CDS. Methods
included literature and program material reviews, key informant interviews, and a
web-based survey about a public repository of CDS artifacts and tools for authoring
standards-based CDS.
Results The evaluation identified important lessons for developing and implementing standards-based
CDS through publicly available repositories such as CDS Connect. Trust is a critical
factor in uptake and can be bolstered through transparent information on underlying
evidence, collaboration with experts, and feedback loops between users and developers
to support continuous improvement. Additionally, while adoption of standards among
electronic health record developers will make it easier to implement standards-based
CDS, lower-resourced health systems will need extra support to ensure successful implementation
and use. Finally, although we found the resources developed by the Initiative to offer
valuable prototypes for the field, health systems desire more information about patient-centered,
clinical, and cost-related outcomes to help them justify the investment required to
implement standards-based, publicly available CDS.
Conclusion While the standards and technology to publicly share standards-based CDS have increased,
broad dissemination and implementation remain challenging.
Keywords
decision support systems - electronic health records - standards-based CDS - implementation
- facilitators and barriers
