Evaluation of the SCaling AcceptabLE cDs (SCALED) Approach of Interoperable Clinical Decision Support for Venous Thromboembolism Prevention


Optimizing Care Delivery for Clinicians


Scaling Effective and Interoperable CDS to Improve Care and Decision Making

A methodology for scaling patient-centered outcomes research into interoperable, shareable clinical decision support tools that are actively maintained with current evidence has the potential to close the evidence-into-practice gap, leading to better patient outcomes.

Shareable clinical decision support: patient-centered outcomes research can translate findings into clinical practice

Recognizing that patients are the best source of information about their needs and preferences, patient-centered outcomes research (PCOR) evaluates questions and results through the lens of what is important to patients and caregivers. Despite agreement that PCOR has the potential to empower patients and improve outcomes, translating PCOR findings into clinical practice is challenging. Interoperable clinical decision support (CDS) tools are an indispensable solution to address this issue, but poor design, lack of interoperability, and implementation barriers hinder adoption. Moreover, the current standard in which each healthcare system develops “home-grown” CDS for the same guidelines is not tenable. Interoperable CDS need to be adaptable to local practice and technology dependencies.

Applying CDS may prevent and treat venous thromboembolism

Patients with traumatic brain injuries (TBI) are at high risk for venous thromboembolism (VTE), a serious condition where a blood clot can develop in the leg or arm and either dislodge or block leg or arm blood flow, causing serious illness, disability, and in some cases, death. But VTE is preventable and treatable if discovered early. To reduce VTE events, patients need preventive care, but guidelines for providing preventive VTE care are only followed about 15 percent of the time in the United States. As a trauma critical care surgeon at the University of Minnesota, Dr. Christopher Tignanelli wants to use a CDS system to improve adherence with best practices for preventing VTE by “nudging” providers treating patients with TBI. This interoperable system will apply Fast Healthcare Interoperability Resources (FHIR) standards and will be adapted from Dr. Tignanelli’s previously developed PCOR CDS tool for COVID-19 VTE prevention. Using the Scaling AcceptabLE cDs (SCALED) approach, the researchers will evaluate the effectiveness of the adapted CDS tool across four healthcare systems, measuring guideline adherence and rates of VTE.

“Our goal was, can we develop this decision support system as an app and make it as easy to scale to other hospitals as you would download an app on your phone.” - Dr. Christopher Tignanelli

Collective efforts support widespread adoption of interoperable CDS

Due to the lack of current robust processes around updating CDS tools as new PCOR evidence emerges, the researchers will also develop and pilot what is referred to as a “Living Guideline” model: a process used to sustain and update evidence-based decision logic. The researchers plan to widely disseminate this new VTE prophylaxis CDS tool for TBI patients to U.S. trauma societies and create an electronic health record-specific ‘playbook’ focused on rapid integration and implementation of PCOR CDS. Researchers hope these collective efforts will help achieve the goal of widespread adoption of these important CDS tools and address the difficulty of implementing PCOR evidence into medical practice.