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Translation of a C. difficile Treatment Clinical Pathway Into Machine-Readable Clinical Decision Support Artifacts Prototyped for Electronic Health Record Integration
Methods Research Report
Investigators: Jeremy Michel, M.D., M.H.S., Emilia Flores, Ph.D., R.N., Nikhil Mull, M.D., and Amy Y. Tsou, M.D., M.Sc.
Author Information and AffiliationsStructured Abstract
Background:
Translating evidence into tools that improve clinical decision making remains an ongoing challenge. In 2018, the ECRI Institute - Penn Medicine Evidence Based Practice Center (EPC) utilized the 2016 AHRQ EPC report update on the Early Diagnosis, Prevention, and Treatment of Clostridium difficile* to develop a clinical pathway for the treatment of Clostridium difficile infection (CDI) in the acute care setting. In this AHRQ EPC methods project, we sought to develop a rigorous process to further translate the previously created CDI treatment clinical pathway into clinical decision support tools prototyped for integration into the Penn Medicine electronic health record (EHR). (*Note that the bacterium Clostridium difficile was renamed Clostridioides difficile in August 2016.)
Methods:
A core team including the pathway program manager at the University of Pennsylvania Health System (UPHS), and physicians with subject matter, evidence synthesis, and informatics expertise was assembled. We developed a step-wise, task based, iterative process to ensure feasibility of evidence translation from the original CDI treatment clinical pathway to our final products. Publicly available tools such as electronic GuideLine Implementation Assessment (eGLIA), Guideline Elements Model (GEM), and the Value Set Authority Center (VSAC) were utilized to perform a systematic, transparent, and reproducible translation process.
Results:
We successfully translated a clinical pathway into machine-readable clinical decision support (CDS) prototyped for EHR integration. Using the CDS Authoring Tool on CDS Connect, we translated this clinical guidance into encoded Clinical Quality Language (CQL) and to support the creation and dissemination of shareable decision support. Findings from this translation effort led to improvements in the source CDI treatment pathway. Following an agile systems development life-cycle process reduced ambiguity and improved clarity for both the source CDI pathway and CDS products.
Discussion:
Several lessons learned emerged from this project. Early and ongoing collaboration between clinical subject experts and the CDS development team accelerated development and adaptation of evidence into machine readable CDS. Future enhancements to the CDS Authoring Tool will enhance its utility and productivity. Our process utilized publicly accessible tools to develop transparent and reproducible CDS products. Moving forward, instruments to assess the quality of clinical pathways and CDS will be necessary to encourage organizations to utilize shareable CDS, a long term goal for repositories such as CDS Connect.
Contents
- Key Messages
- Preface
- Acknowledgments
- Introduction
- Methods
- Preparation for CDS Development
- L3 Clinical Decision Support Development Framework
- Task 1. Extract L2 Recommendation Statements, Classify, and Assess for CDS Inclusion Eligibility
- Task 2. Assess Feasibility and Barriers for Conversion of L2 to L3 CDS Artifact
- Task 3. Group Recommendation Statements by Clinical Phase and Target CDS Channel
- Task 4. Select CDS Intervention Type and Develop Interface Wireframe Prototypes
- Task 5. Parse Recommendations and Restructure Content for Encoding
- Task 6. Meta-Tagging and Creation of Standardized Value Sets
- Task 7. Encode Recommendations Using CQL
- Results
- Task 1. Extract Data, Catalog, and Assess for CDS Inclusion Eligibility
- Task 2. Assess Feasibility and Identify Barriers for Conversion to L3 CDS Artifact
- Task 3. Categorize Recommendation Statements by Clinical Phase
- Task 4. Identify Appropriate CDS Intervention Types To Support Implementation of the CDS Artifact and Develop Interface Wireframe Prototypes
- Task 5. Prepare Content for Encoding
- Task 6. Meta-Tagging and Creation of Standardized Value Sets
- Task 7. Encode Recommendations Using CQL
- Summary of Final Work Products
- Discussion
- Conclusions
- References
- Appendixes
Suggested citation:
Michel J, Flores E, Mull N, Tsou AY. Translation of a Clinical Pathway for C. Difficile Treatment Into a Machine-Readable Clinical Decision Support Artifact Prototyped for Electronic Health Record Integration. Methods Research Report. (Prepared by the ECRI Institute –Penn Medicine Evidence-based Practice Center under Contract No. 290-2015-00005-I.) AHRQ Publication No. 20-EHC001-EF. Rockville, MD: Agency for Healthcare Research and Quality; November 2019. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHQUALIMPRCDIFF.
This report is based on research conducted by the ECRI Institute - Penn Medicine Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00005-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Service
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.
Persons using assistive technology may not be able to fully access information in this report. For assistance contact vog.shh.qrha@CPE.
- NLM CatalogRelated NLM Catalog Entries
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