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October 2015

Sharing Clinical Decision Support:Challenges & Opportunities

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CDS Improves Care

• Clinical decision support (CDS) can improve care by delivering the right clinical guidance at the right time to the right care provider given the context of care.

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Barriers to CDS

• Inputting CDS content into electronic health record (EHR) systems has historically been an onerous and highly manual task.

• The barriers to importing and exporting CDS artifacts cause care to lag behind advances in evidence-based medicine.

• CDS content has been near impossible to share because standard, expressive, computable models for it did not exist

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HL7 DSTU Standard

• Cognitive Medical Systems and Motive Medical Intelligence demonstrated to the VA and ONC the most comprehensive DSTU HL7 standard to date allowing for knowledge artifacts to be ported between proprietary systems.

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Health eDecisions• Developed in response to an ONC Standards &

Interoperability initiative, the Health eDecisions (HeD) Knowledge Artifact specification supports an XML message format and serialization representation for order sets, simple event-condition-action rules, and structured documentation templates (e.g., forms) that ensures content semantics, behavior, and expressiveness can be retained in transmission.

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Structured Knowledge Capture• The HeD specification is an expressive enough

standard to facilitate structured knowledge capture and easier content integration.

• It enables more robust interoperability in systems that support the import and export of such knowledge artifacts

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Automatic Content Integration• If EHRs were built to support it, the HeD knowledge

artifact specification could pave the way for automatically integrating CDS content into clinical workflows and sharing content between systems.

• Vendors could write CDS content once and interpret and deploy across EHRs, and health care organizations could purchase content once and customize

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Benefits for Healthcare Providers• Lower cost to institute and maintain CDS• Faster delivery of the latest clinical guidance

through automatic content updates• More sharable content with greater integrity.

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Next Steps• Lobby Centers for Medicare and Medicaid Services

to make HeD and the knowledge artifact specification part of Meaningful Use