1. Clinical Decision Support Technical Expert Panel Meeting
August 13, 2008
9:00 am - 11:00 am EST

2. Agenda ____________________________
Welcome
Review of July 11th TEP meeting
Contractors’ update and discussion
Discussion topics:
How can usability and workflow of CDS be improved?
How can we engage the quality measurement community?
How should the demonstrations inform CCHIT? 
October 15th meeting at Partners Healthcare (Boston)
Recap and next steps

3. Update on Contractors’ Projects

4. TEP UPDATE August 13, 2008

5. Knowledge Transformation
Project Timeline
Project Planning
Knowledge Transformation
Asthma
Obesity
Phase 1 Implementation
Asthma
Yale Specialty
Phase 2
Implementation
Pre-Implementation
Obesity
Yale PC
Nemours Delaware PC
Asthma
Nemours Orlando
Nemours Jacksonville
Nemours Pensacola
Phase 3
Implementation
Asthma
Yale Primary Care
Nemours Delaware
Dissemination
Evaluation
Jan-April 2008
Mar-June
2008
June-October
2008
October 2008 – June 2009
June-November
2009 5 5

6. Status Summary Guideline transformation is complete
Phase 1 Implementation is in progress
Clinical workflow design is complete for Specialty Clinic (asthma), now integrating new guidelines decision support with existing clinic workflow
Baseline survey of specialist/PCP attitudes/usage of current asthma systems is complete. Analysis underway.
We have identified and addressed several “local factors” in the “zone of localization” (critiquing, Centricity capabilities, primary vs specialty needs)
Newsletter summer edition published
Nemours is commencing some Phase 2 planning work (2-3 months ahead of schedule)

7. Challenge of Representing Guideline Knowledge Electronically
Published Guideline
Black Box
Computer-Based
Guideline Implementation {{
!! A black box stands between the published document and the computer-based decision support tool.
Following poorly defined, largely non-generalizable processes, a published guideline is input into the black box and emerges in some computable format.
!! In many cases, the black box contains an entire academic informatics unit.
Our group has been particularly interested in opening and understanding what goes on in the box. }}

8. Black Box Narrative Guideline Semi-structured Semi-formal Formal

9. Narrative Guideline Semi-structured Semi-formal Formal COGS, AGREE
GLIA
Narrative Guideline
GEM Cutter
XML file
Quality & Implementability Appraisals
Semi-structured
EXTRACTOR Transforms
Statement logic
Coded decision variables & actions
Action-types
Semi-formal
Local workflow & barrier analysis (technical, workflow variance,
people,organizational); local codes; origins/insertions
Formal
Local EHR scripting language; UI choices

10. SmartForm Set Design

11. Next Steps For August/September
Complete integration of asthma DS into existing systems flow, including sign-off from key Yale stakeholders and GLIDES Steering Group
Complete system test planning and finalize roll-out schedule with YNHH systems team
Scheduled to draft interim recommendations for CCHIT and guideline developers

12. Clinical Decision Support Consortium: Technical Expert Panel Meeting Update
August 13, 2008

13. Timeline Overview Year I Year II
Knowledge Management Lifecycle Assessment
Knowledge Translation and Specification
Knowledge Portal & Repository
CDS Web Services Development
Vendor Recommendation/CCHIT
Demo Phase 1: LMR
Evaluation
Dissemination 13

14. Workflow Diagram CDS Dashboards
Specs
CDS Dashboards
Gaps Feedback
Lessons 3
Output Format
Lessons for Survey Creation
Data
Knowledge Translation and Specification
Execution Services
Service Definition
KM Lifecycle Assessment
Models 2
CDS Demonstrations
Lessons 1
Errors and Gaps Feedback
Suggestions for Survey Creation
Input Format
Specs
Recommendations
Recommendations
Catalogs (rules and services)
Lessons 2
Models 1
Gaps Feedback
CCHIT/HITSP
CPG Recommend
Errors and Gaps Feedback
Suggestions for Survey Creation
Recommendations
KM Portal
Quality Data Elements Catalog
Feedback
Feedback
Gaps Feedback
Evaluation
Dissemination 14

15. Accomplishments to Date
KM Lifecycle Assessment Team
Completed Knowledge Management and CDS Survey. Survey sent out to Consortium sites and has been returned by PHS and Regenstrief.
Conducted PHS Site Visit on June Interviewed and shadowed Partners physicians to assess their knowledge management and CDS practices.
Knowledge Translation and Specification Team
Completed semi-structured representation and presented work to AHRQ and TEP ( July 11th TEP meeting).
KM Portal
Delivered eRoom as a collaborative environment for CDSC activities. Finalized KM Portal design hardware.
Vendor Generalization and CCHIT Team
Completed capability reviews of nine EHR systems’ decision support features through customer interviews. Findings will be incorporated into the first set of recommendations to CCHIT.
CDS Services Development
Completed CDS literature review on current service-oriented architectures.
Joint Information Modeling Working Group
Selected information model and terminologies.

16. Current Status of Working Teams
KM Lifecycle Assessment
Analyzing data from Partners site visit
Planning for site visit to Regenstrief/VA (9/29/08-10/3/08)
Knowledge Translation and Specification
Assessing content for the CDSC Action model
Refining semi-structured usage/utilization metric
Completing XML schema for semi-structured representation
KM Portal
Completing draft of the use case diagram for collaboration use case
Vendor Generalization/CCHIT
Engaging with CCHIT, HITSP, knowledge vendors
Preparing to draft first set of recommendations to CCHIT and HITSP
Contacting CPG community about demonstration 16

17. Current Status of Working Teams (cont.)
CDS Services Development
Reviewing Action model and developing rules engine
CDS Evaluation Team
Working with team leads to finalize individual CDSC team evaluation plans
Dissemination Team
Drafting Masspro Dissemination vision document, to be presented to team September, 2008
Joint Information Modeling Working Team
Collaborating with KTS and Services Development team to develop action model and UML representation of patient data model 17

18. Upcoming Milestones Date Team Milestone 8/13/08
CDS Services Evaluation Team
Present draft evaluation instrument to services team
8/22/08
JIM team; KTS team; CDS Services Development team
CCD action model
9/18/08
KTS team
Complete encoding of content into semi structured representation 18 18

19. Dissemination: Contacting CPG Community
Anne Diamond
American College of Obstetricians and Gynecologists (ACOG)
Steve Downs, MD, MS
American Academy of Pediatrics (AAP)
Jim Dove, MD, FACC
American College of Cardiology (ACC)
Robert Haralson, MD
American Academy of Orthopedic Surgeons (AAOS)
Mark Helfand, MD, MPH
Oregon Health and Sciences Univ. (OHSU)
Kevin Johnson, MD, MS
Norman Kahn, MD
Council of Medical Specialty Societies (CMSS)
William McGivney, PhD
National Comprehensive Cancer Network (NCCN)
Virginia Moyer, MD, MPH
Baylor College of Medicine/USPSTF
Doug Owens, MD, MS
American College of Physicians (ACP)
Rick Shiffman, MD, MCIS
Yale University
Janet Wies, MPH
Initial contact made on July 30, of the 12 contacts have responded.
Meetings with contacts will be scheduled to discuss how to best engage their organization.
Steve Downs and Kevin Johnson suggested including Paul Biondich at the Partnership for Policy dfImplementation.
Jennifer Mansour was suggested as a contact for the American Academy of Pediatrics.

20. Discussion Topics How can usability and workflow of CDS be improved?
How can we engage the quality measurement community?
How should the demonstrations inform CCHIT?