AHRQ – Advancing Evidence into Practice through Shared, Interoperable Clinical Decision Support Resources (U18)

May 25, 2018 by School of Medicine Webmaster

Clinical decision support (CDS) provides patient-specific information and knowledge, enabled by health IT, to clinicians, patients, or other individuals to enhance health and health care (Mardon et al., 2014). CDS includes processes and mechanisms that aim to deliver the right information, to the right person, using the right format, in the right channel, and at the right time during workflow (often referred to as the “5 Rights” framework; Osheroff, 2009). Well-implemented, electronic CDS can improve health care processes (Lobach, 2012).

AHRQ has a long history of making significant investments in CDS as a means to advance research evidence into clinical practice. Despite widespread adoption of electronic health records (EHRs), challenges remain about how to best leverage health IT, including CDS, to improve health care quality. In 2017, the National Academy of Medicine (NAM) released a special publication, “Optimizing Strategies for Clinical Decision Support,” which outlined thirteen priorities for collaborative action (NAM, 2017). These priorities include creating a national CDS repository, developing a multi-stakeholder CDS learning community, and establishing an investment program for CDS research. AHRQ is beginning to address some of these priorities with support from the Patient-Centered Outcomes Research Trust Fund.

In 2016, AHRQ convened the Patient-Centered CDS Learning Network (PCCDS LN) as a cooperative agreement grant to RTI International (see https://www.healthit.ahrq.gov/ahrq-funded-projects/patient-centered-outcomes-research-clinical-decision-support-learning-network#h=learning network). The PCCDS LN is a multi-stakeholder learning community that informs and connects a wide variety of perspectives to address the challenges and opportunities of translating evidence, including patient-centered outcomes research findings, into patient-centered CDS.

In 2017, AHRQ launched a repository for CDS knowledge artifacts known as CDS Connect (see https://cds.ahrq.gov/cdsconnect). CDS Connect is a platform for hosting CDS and making CDS more shareable, standards-based, and publicly-available. CDS Connect currently includes CDS from a variety of clinical domains such as cholesterol management, opioids and pain management, and diabetes. In addition, CDS Connect includes an open-source and freely-available CDS authoring tool. The authoring tool enables non-technical users to develop interoperable CDS logic according to the HL7 Clinical Quality Language (CQL) standard. CQL harmonizes the logic shared by both CDS and electronic clinical quality measures (eCQMs), and the Centers for Medicare & Medicaid Services recently announced its use for programs that require eCQMs. (CMS, 2017)

Shareable, interoperable CDS tools and resources, are meant to reduce the burden of developing and implementing CDS from scratch. Currently, health care systems translate clinical practice guidelines and other evidence-based recommendations into CDS in siloed fashion, leaving opportunities to share lessons learned and to build on collective experience and knowledge unrealized. Research is needed on how to best leverage shareable, interoperable CDS resources as means of making CDS development and implementation more efficient, thereby making it easier to advance evidence into practice through CDS.

Objectives and Scope

The goal of this funding opportunity is to conduct innovative research on broadly disseminating Patient-Centered Outcomes Research (PCOR) findings into clinical practice through CDS. Further, this opportunity aims to assist users of health IT focused on CDS through developing and building upon shareable, interoperable CDS resources such as those available on CDS Connect. Ultimately, AHRQ desires to have the CDS resources developed through these awards to be publicly-available, interoperable, and shareable on CDS Connect for further innovation, evaluation, and use in the field. Since AHRQ desires to support innovation through this funding opportunity, a wide range of applicants, including for-profit private institutions, are encouraged to respond (see Section III below).

Highly responsive applications will include:

1. Use of the CDS authoring tool to develop:

  • Computable guideline recommendations that use the CQL standard. Guidelines are currently written in text-based form and need to be translated into computable form for integration and implementation in EHRs. Using the CDS authoring tool to write recommendations can accelerate the translation of guidelines into CDS and can ensure the CDS is consistent with guideline authors’ intentions. Research is needed on how a CDS authoring tool can make guidelines more computable, thus expediting their dissemination through EHRs and other health IT.
  • CDS as part of patient-facing apps that can integrate with EHRs and other health IT (e.g., CDS that triggers a risk assessment questionnaire completed by patients and displays results and recommendations to providers).
  • CDS based on PCOR findings that can be posted to the CDS repository for sharing and dissemination to other sites. The CDS may take various forms, such as:
  • CDS aimed towards not just physicians at the point of care but towards other members of the care team (e.g., nurses, care coordinators, population health managers, community health workers)
  • SMART on FHIR apps that use the CQL generated by the CDS authoring tool; or

2. Use of the repository and the CDS artifacts already available through CDS Connect, such as:

  • Building additional functionality or new ways to present the CDS to end-users
  • Implementing and evaluating CDS in new sites and settings
  • Developing and sharing methods for accessing CDS from the repository
  • Using application programming interfaces (APIs) to integrate with other health IT (e.g., CDS services that automate updates when artifacts on CDS Connect change)
  • Finding innovative ways to incorporate patient or caregiver preferences in the CDS
 Proposed applications must:
  • Incorporate the “5 Rights” framework of delivering the right information, to the right person(s), using the right format, in the right channel, and at the right time during workflow (Osheroff, 2009);
  • Assess usability and incorporate user-centered design
  • Incorporate Clinical Quality Language (CQL) and other HL7 standards, if appropriate, for developing and integrating their CDS with EHRs and other health IT.
  • Describe the PCOR finding including appropriate citations, level of evidence that forms the basis for the proposed CDS
  • Identify project staff who will become active members of the AHRQ PCCDS Learning Network to share experiences and learn from others across the CDS community
Proposed applications are encouraged to:
  • Build on tools and resources currently available through CDS Connect, such as the authoring tool or CDS artifacts available on the repository
  • Use resources available through the PCCDS LN, such as the Analytic Framework for Action, which represents a life cycle of patient-centered CDS, including prioritizing, authoring, implementing, and measuring CDS interventions.
  • Collaborate with the PCCDS LN and other efforts aimed at sharing and disseminating best practices across the CDS community

Deadlines:  standard dates apply

URL:  https://grants.nih.gov/grants/guide/pa-files/PA-18-792.html

Filed Under: Funding Opportunities