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首页> 外文期刊>BMC Medical Informatics and Decision Making >A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties
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A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties

机译：用于定义适用于医学专业的临床决策支持目标的概念框架和协议

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Background 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.
机译：背景技术美国医疗保险和医疗补助服务中心在2009年建立了电子健康记录（EHR）激励计划，以鼓励采用EHR。该计划的一个组成部分要求合格的提供者实施临床决策支持（CDS）干预措施，以提高针对每个专业预先选择的一项或多项质量指标的绩效。由于不同专业之间独特的决策挑战和现有的HIT能力差异很大，因此在此类程序中为CDS制定有意义的目标必须得到认真分析的支持。设计我们开发了一个概念框架和协议，将证据审查与专家意见相结合，直接从专家那里得出CDS的具有临床意义的目标。该框架将CDS的目标与特定于专业的绩效差距联系在一起，同时确保提供商可以使用一组可行的CDS机会来解决每个绩效差距。绩效差距可能包括那些具有完善质量指标的差距，也包括专家根据其临床经验确定的优先事项。此外，目标不限于与现有CDS技术之间的性能差距，而可以包括可以预期在短期内（例如，在EHR激励计划的第3阶段开始之前）开发CDS工具的目标。该协议使用改进的Delphi专家小组程序来得出CDS有意义的使用目标并对其进行优先级排序。专家首先评价绩效差距的重要性，首先是通过环境扫描生成的候选人名单，再由专家小组成员的提名予以补充。对于最优先的绩效差距，小组成员然后对现有或将来的CDS干预措施（共同称为“ CDS机会”）可能会影响每个绩效差距的程度以及每个CDS机会与专家的临床工作流程兼容的程度进行评估。该协议由代表四个临床专业的专家小组测试：肿瘤学，整形外科，介入性心脏病学和儿科。

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