Clinical Decision Support Consortium

In order to realize the quality and safety benefits of electronic health records (EHRs), they must be paired with clinical decision support (CDS) systems. CDS systems use a variety of techniques to facilitate and guide clinical decisionmaking toward evidence-based practice. Although benefits of CDS are clear, there have been a number of barriers to its widespread adoption, including the complexity of the CDS; difficulty translating medical knowledge and guidelines into a form that can be used by EHRs; a lack of understanding of how to create the initial building blocks of CDS; identifying actual costs; and identifying a process for maintaining and keeping existing CDS current.

This 5-year project, the Clinical Decision Support Consortium (CDSC), worked on assessing, defining, demonstrating, and evaluating best practices for knowledge management (KM) and CDS in health information technology (IT) across multiple ambulatory care settings and EHR technology platforms. Members of the CDSC included academic and community provider institutions, leading health IT organizations, EHR companies, and knowledge vendors.

The main objectives of the project were to:

• Assess and define best practices for knowledge management and CDS in ambulatory care.
• Define a novel, practical knowledge representation scheme that allows users to access knowledge in a manner that facilitates the translation of knowledge into CDS within EHRs.
• Build a prototype national knowledge repository to support access and use of knowledge artifacts and collaborative knowledge engineering.
• Build publicly available cloud-based Web services to provide remote CDS.
• Build end-user CDS dashboards that would depict user's compliance with CDS and provide feedback to knowledge engineers on the efficacy of the CDS.
• Coordinate overall CDS Consortium evaluation activities.
• Demonstrate the feasibility of a service oriented architecture-based approach through multi-site, multivendor demonstration projects.
• Disseminate results through a variety of traditional channels.

The accomplishments of the CDSC are detailed on the CDSC Web site: http://www.partners.org/cird/cdsc/. The CDSC solved critical technical challenges for sharing CDS and developing social and legal frameworks that facilitate such sharing. The project selected a service-oriented approach to providing clinical decision support. Web services were developed at Brigham and Women’s Hospital, the lead CDSC site, and made available to consumers across the US. In addition, the consortium designed, developed, and implemented cloud-based CDS services, as well as both human and human-readable artifacts, subsequently made available through a publicly accessible knowledge portal. CDSC contributed to the development of the Health eDecisions standards for CDS, and provided important feedback about the Continuity of Care Document standard.

The project was able to demonstrate that CDS developed at one site can be used at a variety of sites, including those that have different EHRs. This approach should be able to surmount current challenges in scalability and sharing for CDS. With the CDSC model, a small number of academic or commercial providers could develop high-quality decision support content that could be deployed across a wide range of clinical settings, resulting in a dramatic reduction in the cost of KM and development of CDS, allowing smaller organizations to deploy more and higher-quality CDS.