BMC Med Inform Decis Mak - A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

Tópicos

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{ ehr(2073) health(1662) electron(1139) }
{ control(1307) perform(991) simul(935) }
{ data(3008) multipl(1320) sourc(1022) }
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Resumo

CKGROUND: The U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DESIGN: We developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics.

Resumo Limpo

ckground us center medicar medicaid servic establish electron health record ehr incent program stimul adopt ehr one compon program requir elig provid implement clinic decis support cds intervent can improv perform one qualiti measur preselect specialti uniqu decisionmak challeng exist hit capabl vari wide across specialti develop meaning object cds within program must support delib analysisdesign develop conceptu framework protocol combin evid review expert opinion elicit clinic meaning object cds direct specialist framework link object cds specialtyspecif perform gap ensur workabl set cds opportun avail provid address perform gap perform gap may includ wellestablish qualiti measur also prioriti identifi specialist base clinic experi moreov object constrain perform gap exist cds technolog rather may includ cds tool might reason expect develop near term exampl begin stage ehr incent program protocol use modifi delphi expert panel process elicit priorit cds meaning use object expert first rate import perform gap begin candid list generat environment scan supplement nomin panelist highest prioriti perform gap panelist rate extent exist futur cds intervent character joint cds opportun might impact perform gap extent cds opportun compat specialist clinic workflow protocol test expert panel repres four clinic specialti oncolog orthoped surgeri intervent cardiolog pediatr

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