Translating Hypertension Guidelines into Practice: Development of Interoperable Clinical Decision Support (Oregon)

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Project Details - Ongoing


Clinical guidelines, today written in narratives, summarize both evidence-based recommendations, as well as expert opinion. Up to half of the recommendations in guidelines for cardiovascular care contain expert opinion or common practices without strong evidence from research. In addition, application of these guidelines must be tailored to specific patient situations, accounting for the severity of their disease, comorbid conditions, age, race, and their preferences. Therefore, guidelines vary and may conflict. The existence of competing guidelines, the need to tailor guidelines to specific situations and patients, and the delay in adopting new guidelines has led to significant variations in treatment. Clinical decision support (CDS) implemented at the point of care holds the promise of presenting current guidance to clinicians, with the capability to incorporate patient-centered elements. Historically, however, CDS has been locally developed and not designed to be shareable and reusable across systems. In addition to the expense and duplication of work across different systems, updating these tools as new guidance emerges is rarely completed in a timely fashion.

With the emergence of new tools, it has become technically feasible to create shareable, reusable CDS tools that are vendor neutral such that, as guidelines are updated, the CDS reflecting them may be quickly updated and made widely available. This research will translate hypertension guidelines into interchangeable code utilizing the AHRQ CDS Connect authoring tool, Clinical Query Language (CQL), and Fast Healthcare Interoperability Resources (FHIR) standards. Hypertension was chosen as an initial focus due to the existence of conflicting guidelines, its complexity, and the need to capture patient preferences and local standards.

The specific aims of the research are as follows:

  • Translate multiple hypertension guidelines and protocols into CQL query modules. 
  • Build CDS artifacts using the CDS Connect Authoring tool and build an FHIR application that can elicit inputs and provide guidance to both patients and healthcare teams. 
  • Evaluate this application with appropriate patients and healthcare teams to learn its potential impact in assisting tailored decision making, refining the CDS artifacts, and disseminating. 

In the early stages of the research, an interdisciplinary team and patients will convert multiple hypertension guidelines and protocols into CQL query modules, making decisions around which guidance to adopt where there are conflicts. CDS components will then be built using the CDS authoring tool, with a subsequent application developed using FHIR standards. This application will be validated against an existing database of patients with hypertension. Use of the application by patients and healthcare teams will be evaluated in order to understand its impact on decision making. Finally, the application will be disseminated and make publicly available, with the researchers measuring how often it is used and adapted. The successful completion of this research will set the stage for widespread integration of guidelines as shareable, reusable CDS tools.