Advancing patient-centered clinical decision support in today's health care ecosystem: key themes from the Clinical Decision Support Innovation Collaborative's 2023 Annual Meeting.

Objective: This perspective summarizes key themes that arose from stakeholder discussions at the inaugural Clinical Decision Support Innovation Collaborative (CDSiC) 2023 Annual Meeting. The CDSiC is an Agency for Healthcare Research and Quality (AHRQ)-funded innovation hub for patient-centered clinical decision support (PC CDS).

Materials And Methods: The meeting took place on May 16-17, 2023, and engaged 73 participants that represented a range of stakeholder groups including researchers, informaticians, federal representatives, clinicians, patients, and electronic health record developers.

AHRQ's digital healthcare research program: 20 years of advancing innovation and discovery.

Objectives: To reflect on the achievements of the Agency for Healthcare Research and Quality's (AHRQ) Digital Healthcare Research Program over the past 20 years, evaluate its impact on US healthcare quality and safety, and outline current and future priorities for digital healthcare research and innovation.

Process: The article reviews key milestones in AHRQ's digital healthcare initiatives, including its founding and its advances in telehealthcare and clinical decision support. It highlights AHRQ's contributions to advancing technology integration in healthcare, promoting patient safety, and addressing equity gaps.

Patient-centered clinical decision support challenges and opportunities identified from workflow execution models.

Objective: To use workflow execution models to highlight new considerations for patient-centered clinical decision support policies (PC CDS), processes, procedures, technology, and expertise required to support new workflows.

Methods: To generate and refine models, we used (1) targeted literature reviews; (2) key informant interviews with 6 external PC CDS experts; (3) model refinement based on authors' experience; and (4) validation of the models by a 26-member steering committee.

Results And Discussion: We identified 7 major issues that provide significant challenges and opportunities for healthcare systems, researchers, administrators, and health IT and app developers.

Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support.

Background: Clinical decision support (CDS), which provides tools to assist clinical decision-making, can improve adherence to evidence-based practices, prevent medical errors, and support high-quality and patient-centered care delivery. Publicly available CDS that uses standards to express clinical logic (i.e.

A lifecycle framework illustrates eight stages necessary for realizing the benefits of patient-centered clinical decision support.

The design, development, implementation, use, and evaluation of high-quality, patient-centered clinical decision support (PC CDS) is necessary if we are to achieve the quintuple aim in healthcare. We developed a PC CDS lifecycle framework to promote a common understanding and language for communication among researchers, patients, clinicians, and policymakers. The framework puts the patient, and/or their caregiver at the center and illustrates how they are involved in all the following stages: Computable Clinical Knowledge, Patient-specific Inference, Information Delivery, Clinical Decision, Patient Behaviors, Health Outcomes, Aggregate Data, and patient-centered outcomes research (PCOR) Evidence.

Creating implementable clinical practice guidelines: the 2020 Focused Updates to the National Heart, Lung, and Blood Institute's Asthma Management Guidelines.

Background: The 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group provides the first new clinical practice recommendations from the National Heart, Lung, and Blood Institute (NHLBI) since the previous 2007 asthma management guidelines. Guideline implementability was a high priority for the expert panel, and many approaches were undertaken to enhance the implementability of this clinical guideline update. Within the report, specific implementation guidance sections provide expanded summaries for each recommendation to quickly assist users.

Integrating a Patient Engagement App into an Electronic Health Record-Enabled Workflow Using Interoperability Standards.

Background: Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare Interoperability Resources (FHIR) offers a standards-based application programming interface (API) that may support such integration.

Nothing for Me or About Me, Without Me: Codesign of Clinical Decision Support.

Background: Partnerships among patients, families, caregivers, and clinicians are critical to helping patients lead their best lives given their specific genetics, conditions, circumstances, and the environments in which they live, work, and play. These partnerships extend to the development of health information technology, including clinical decision support (CDS). Design of these technologies, however, often occurs without a profound understanding of the true needs, wants, and concerns of patients and family members.

To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support.

Background: Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details.

Objective: Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or "artifacts.

The Imperative for Patient-Centered Clinical Decision Support.

This commentary introduces the Patient-Centered Clinical Decision Support (PCCDS) Learning Network, which is collaborating with AcademyHealth to publish "Better Decisions Together" as part of . Patient-centered clinical decision support (CDS) is an important vehicle to address broad issues in the U.S.

Enhancing Health IT Functionality for Children: The 2015 Children's EHR Format.

Electronic health record (EHR) use throughout the United States has advanced considerably, but functionality to support the optimal care of children has been slower to develop and deploy. A previous team of experts systematically identified gaps in EHR functionality during collaborative work from 2010 to 2013 that produced the Children's EHR Format (Format), funded under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law 111-3. After that, a team of practitioners, software developers, health policy leaders, and other stakeholders examined the Format's exhaustive list of 547 EHR functional requirements in 26 topic areas and found them to be valuable but in need of further refinement and prioritization.

Pediatric health care quality measures: considerations for pharmacotherapy.

Measuring the quality use of medicines can be conceptualized as a mechanism for understanding appropriate use, underuse, overuse, or misuse. For pediatric pharmacotherapy, measuring the quality use of medicines requires awareness of the differences in health care between children and adults and the differences in the quality and quantity of science that supports evidence-based practice in pediatric health care compared with adult health care. Here we use the Pediatric Quality Measures Program that arose from the Children's Health Insurance Program Reauthorization Act in the United States to illustrate the challenges in developing quality measures of pediatric pharmacotherapy.

Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists.

Purpose: To investigate use of a new guideline-based, computerized clinical decision support (CCDS) system for asthma in a pediatric pulmonology clinic of a large academic medical center.

Methods: We conducted a qualitative evaluation including review of electronic data, direct observation, and interviews with all nine pediatric pulmonologists in the clinic. Outcome measures included patterns of computer use in relation to patient care, and themes surrounding the relationship between asthma care and computer use.

Accuracy of a computerized clinical decision-support system for asthma assessment and management.

Objective: To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic.

Design: Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009.

Measurements: CDSS and physician assessments of asthma severity, control, and treatment step.