Great Challenges and Opportunities for Patient-Centered CDS | Tech Rasta

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Dr. Prashila Dullabh is vice president and senior colleague of NORC at the University of Chicago. and director of the NORC Health Operations Science Center. She serves as the principal investigator for the Clinical Decision Support Innovation Collaborative Program.

She co-authored the paper with Dean Sittig, NORC senior fellow and professor of biomedical informatics at the University of Texas Health Science Center and CDSiC project co-author; Dr. David Lobach, Vice President of Health Informatics Research at Elimu Informatics and co-author of the CDSiC Project; James Swiger, Administrator Health Scientist in the Digital Healthcare Research Division in the Center for Evidence and Practice Improvement at the Agency for Healthcare. Research and Quality; and Dr. Edwin Lomotan, Head of Clinical Information Division of Digital Healthcare Research in the Center for Evidence and Practice Improvement at AHRQ.

Patient-Centered Healthcare Services equality and based on evidence It is increasingly recognized as a target for the US health care system. The need to look forward to and continue to work. As part of the Department of Health and Human Services, the Agency of Healthcare Research and Quality’s is trying to make the US healthcare system better. It is shifting towards the ability to give patients, caregivers and their care teams access to evidence-based advice to guide clinical decision-making. that combines the needs and preferences of the patient

Since 2016, AHRQ has been funding projects. Focused on defining, tailoring and improving the receipt of patient-centered outcomes research through technology-based clinical decision support tools.

In this view, we summarize the challenges and opportunities facing patient-centered CDS, or PC CDS, highlighting key findings from the Journal of the American Medical Informatics Association: Challenges and Opportunities for Medical Decision Support. Patient-centered clinics: results from horizon scans. [1]

What is patient-centered clinical decision support?

Traditional CDS includes digital tools that provide timely information. which is usually at the point of care To help clinicians make informed decisions about patient care, while traditional CDS has to turn to physicians, PC CDS is patient-facing and can be shared. PC CDS offers a new way to combine views. of patients, caregivers and families into evidence-based care facilitated by digital tools.

PC CDS includes patient-provided information, such as information from medical devices. wearable device and patient-reported outcomes surveys. as well as social determinants of health data and patient preferences. directly in the office, home, or other community environment. PC CDS also supports patients and providers to participate in the collective decision-making process. taking into account the needs and preferences of the patient

The recent COVID-19 pandemic has provided a natural test bed for identifying new methods. at digital tools and technology which focuses on patients and caregivers can support patient-centered care

Remote monitoring app for COVID-19 that collects and uses patient-reported data (such as oxygen saturation, respiration rate, temperature) to help physicians manage patient care recommendations is an example of a new PC CDS tool. However, to ensure we have a digital ecosystem that supports the full realization of the benefits of PC CDS, we face challenges. some important

The main challenges facing PC CDS in the future

1. Build trust and transparency in PC CDS The patient-centered PC CDS will increase the usefulness of the PC CDS tool for both patients and providers. This requires building trust. Before they were involved in making the PC CDS tools work perfectly continuously. Patients and providers must trust the baseline research and evidence prioritization included in the PC CDS tool.

Providers can further benefit from understanding how the evidence used in PC CDS can inform conversations with patients. Ensuring that health apps and other PC CDS tools meet safety and quality criteria increases patient and provider confidence in the reliability and accuracy of these tools. Especially when apps involve decision support.

Finally, patients and providers need to be assured that PC CDS tools are regularly updated as evidence changes. The adoption of transparency in PC CDS development from clinical practice can only increase the adoption and use of PC CDS.

2. Includes patient data entry at all stages of PC CDS development. Understanding the patient’s needs, desires, expectations, and strengths It is critical to the development of PC CDS by definition. But achieving this understanding requires meaningful and lasting patient involvement. We must prioritize patient involvement and meaningful patient input throughout the PC CDS development cycle, incorporating patient preferences carefully and in many ways.

early patient involvement in the research process Help ensure that research-based evidence-based guidelines are truly patient-centered. And those guidelines are understood and prioritized in a way that maximizes patient involvement in PC CDS. Currently, the design of PC CDS does not take into account the different decision-making processes of patients and providers.

A better understanding of the literature on individual and collective decision-making processes will enable PC CDS developers to target interventions to promote SDM and accurately reflect patient goals and preferences. Industry-wide principles and guidelines are needed for a safe and effective way to deliver PC CDS to patients that match the patient’s life flow. We must engage in design activities with patients to develop designs that deliver the right information at the right time in the right format to ensure patient participation.

3. Development of technical standards for PC CDS tools A variety of technical standards are needed to develop PC CDS, including requirements for interoperability between semantic (e.g. data content) and syntax (e.g. interchange standards). to show and share knowledge A standard for exchanging device/wearable information. and standards for recording patient preferences.

Additionally, the inclusion of patient-generated health data in ‘real’ electronic health records will restrict PC CDS tools from giving the patient the most attention. A key component of PC CDS is ensuring that instructions are run at the right time in the doctor and patient workflow. Although there are specialized application program interfaces based on standards such as CDS Hooks, there is still high variance in support for EHR developers and the implementation of these standards. We have seen advancements in technical standards. But there is still a lot of work still going on.

4. Improvement of measures and methods of monitoring PC CDS tools This ensures that PC CDS interventions improve physician and patient decision-making and health outcomes. We need to accurately measure and validate the performance of various PC CDS models. Measurement efforts to date have primarily focused on assessing the feasibility and acceptance of PC CDS.

Progress has been made to measure PC CDS “success” in studies that measure knowledge acquisition. stimulation of the patient patient satisfaction and quality of life But there is still a lack of evidence as to which forms of PC CDS work best for different clinical symptoms and patient preferences. To inform an important and targeted assessment of PC CDS, we need more comprehensive measurements that are important to patients.

answer the challenge

In September 2021, AHRQ funded the Clinical Decision Support Innovation Collaborative (CDSiC). The CDSiC aims to advance the design, development, release, implementation, implementation, measurement and evaluation of PCs. CDS CDSiC will support four work groups. A group focused on scaling and measuring outcomes, patient-centered trust and care. and standards and regulatory frameworks.

The working group will develop tools and products that help address some of the key PC CDS challenges by providing advice and guidance related to:

  • Increase the reliability of PC CDS sources.
  • Include patient-centered inputs in PC CDS and patient involvement in the joint design of PC CDS.
  • Fixing gaps in existing PC CDS standards and regulatory frameworks
  • Identification of outcome measures and guidelines for measuring the impact of PC CDS

The CDSiC Innovation Center will also pursue real-world projects and research projects to develop CDS for standard PCs. To achieve its goals, CDSiC will use the expertise of a wide range of stakeholders – including patients, physicians, researchers, health information technology. CDS (Health IT) and CDS Developers, Informatics, Payers and Policy Makers. CDSiC provides the field with unique opportunities to address the technical challenges of “innovation”. cross-cutting PC CDS


[1] The JAMIA article is based on AHRQ-funded horizon scans to explore the current state of PC CDS and to identify future directions for research and development. The scan includes a comprehensive literature review. Data from a panel of 22 experts and discussion of 18 key informants.

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