Edwin Lomotan, MD Agency for Healthcare Research and Quality Twitter: #AMIA2017

1. Accelerating Evidence into Practice: • AHRQ’s Clinical Decision Support Initiative Overview Session Number: S121 Edwin Lomotan, MD Agency for Healthcare Research and Quality Twitter: #AMIA2017

2. Disclosure • I and my spouse have no relevant relationships with commercial interests to disclose. AMIA 2017 | amia.org

3. Learning Objectives • After participating in this session the learner should be better able to: • Apply the Analytic Framework for Action to clinical decision support and quality improvement processes within their organization. • Formulate an approach to incorporating patient preferences and values when developing and implementing clinical decision support. • Access, view, and download clinical decision support artifacts available through CDS Connect. AMIA 2017 | amia.org

4. Presentations Barry Blumenfeld MD, MS Edwin Lomotan, MD Kym Martin, MBA Rob McCready, MS AMIA 2017 | amia.org

5. AHRQ Clinical Decision Support • Long history of AHRQ investment in clinical decision support • Investigator-initiated research • Demonstration contracts • Foundational work on data models to support both CDS and electronic clinical quality measurement • New initiative in 2016 • Based on legislative requirements from the Patient Protection and Affordable Care Act • Focuses on working with stakeholders, including patients, developers of CDS, and many others to accelerate the movement of evidence into practice through CDS AMIA 2017 | amia.org

6. AHRQ CDS Initiative • Advancing evidence into practice through CDS and making CDS more shareable, standards-based, and publicly-available • Four components: • Engaging a stakeholder community • Creating prototype infrastructure forsharing CDS and developing CDS • Advancing CDS through demonstrationand dissemination research • Evaluating the overall initiative AMIA 2017 | amia.org

7. CDS Connect Session Number: S121 Rob McCready The MITRE Corporation Twitter: #AMIA2017

8. Disclosure • I and my spouse have no relevant relationships with commercial interests to disclose. AMIA 2017 | amia.org

9. CDS Connect • Mission: Demonstrate a system that supports new evidence-based standards of care, codifies Clinical Decision Support (CDS) artifacts based on those standards using an interoperable, international data standard, and shares the resulting CDS capabilities via an accessible, web-based tool. • Activities: • Repository: Design and build an online software “repository” for hosting and sharing new CDS artifacts • Authoring: Build a public facing, web-based CDS Authoring tool geared toward non-technical users • Artifacts: Identify and codify new CDS artifacts for care, initially in the domain of cholesterol management • Pilot: Pilot CDS artifacts in a live, clinical setting • Work Groups: Convene external discussions focused on accelerating evidence into practice through CDS • Sponsor: Agency for Healthcare Research and Quality AMIA 2017 | amia.org

10. CDS Connect Concept of Operations AMIA 2017 | amia.org

11. CDS Connect cds.arhq.gov/cdsconnect AMIA 2017 | amia.org

12. CDS Connect Artifact Development • Identify and develop new CDS artifacts for initial content of the CDS Connect Repository • Drives Repository and Authoring Tool software requirements • Provides an example to potential contributors to the repository • 2018 CDS development focused in the domain of Opioids and Pain Management • Theme for 2018 will be "teach the world to fish” with CDS Connect • Encouraging CDS Connect community to contribute content directly on the CDS Repository and through the CDS Authoring Tool AMIA 2017 | amia.org

13. Live and Operational Pilot • Goal: Pilot the CDS Connect Concept of Operations, including the MITRE developed CDS artifact in the domain of opioid and pain management in a live, clinical setting • Benefits: • Ensures that the CDS artifacts perform as expected • Experience will be used to refine the CDS artifacts and inform the CDS Repository • Evaluates the efficacy of the CDS artifacts and development process • Demonstrates the ability to change and enhance the CDS and associated logic based on AMIA 2017 | amia.org

14. Live and Operational Pilot • In 2017, CDS Connect supported a pilot with a multidisciplinary team in partnership with AllianceChicago: • Live pilot in July-August 2017 (4 weeks) • Hosted at a Federally Qualified Health Center (FQHC) in a rural community • For 2018, seeking a pilot collaborator: • Focused on opioids and pain management • Healthcare provider with forward-facing Electronic Health Record system or CDS system • Expressing 1 or more CDS artifacts in the opioid and pain management domain via the CQL standard AMIA 2017 | amia.org

15. Work Group Engagement • The CDS Connect Work Groups are volunteer advisory groups established to: • Identify and validate the design for capabilities and functionality for the CDS Repository, while • Informing and guiding the design, development and inclusion of Opioid and Pain Management CDS artifacts. The Work Group will support ongoing collaboration and engagement efforts to fulfill the AHRQ requirement to engage stakeholders in the development and promotion of CDS AMIA 2017 | amia.org

16. Work Group Concept of Operations AMIA 2017 | amia.org

17. Thank you! Email me at: rob@mitre.org

18. The Patient Centered CDS Learning Network Session Number 121 Barry Blumenfeld, MD, MS RTI International Twitter: @bblumenfeld, @pccdsln

19. Disclosures • I am an employee of RTI International • Support for this work was provided under AHRQ grant:1U18H5024849-01 • Developed in Collaboration with: • Blackford Middleton, MD, MPH, MsC • Jerome Osheroff, MD • Kensaku Kawamoto, MD, PhD • Robert Greenes, MD, PhD • Joshua Richardson, PhD, MS, MLIS • Laura Marcial, PhD • Beth Lasater, MS AMIA 2017 | amia.org

20. What is the Patient-Centered CDS Learning Network? • The Patient-Centered Clinical Decision Support Learning Network (PCCDS-LN) is an Agency for Healthcare Research and Quality (AHRQ)-supported effort that brings together diverse stakeholders to promote a sustainable community around developing, disseminating, and applying evidence-enabled, PCCDS AMIA 2017 | amia.org

21. The Ingredients of PCCDS Evidence +

22. Defining PCCDS… • Patient-Centered Clinical Decision Support (PCCDS) is: • CDS that supports individual patients and their approved care givers and/or care teams in health-related decisions and actions by leveraging information from patient centered outcomes research findings and/or patient-specific information (e.g. patient-generated health data).

23. Our Vision • Patients have PCCDS seamlessly integrated into their daily lives for managing their conditions and optimizing their health • Providers have PCCDS seamlessly integrated into their clinical workflows • Development is driven by both researchers and patients. • Best practices encourage incorporation of patient preferences to personalize the CDS • Personal belief structures and values (we should have ice cream for all) • Personal preferences (I like strawberry) • Personal utilities (quantified values) (I’ll have 2 scoops)

24. The Analytic Framework for Action (AFA) • The Analytic Framework for Action represents the lifecycle of activities that must occur in order to disseminate evidence based research findings through PCCDS, implement them in practice, measure impact, and create a learning system. • At each step in the AFA there are factors that must be addressed to achieve success • We use the AFA as an organizing model for our initiatives to improve dissemination and adoption of PCCDS AMIA 2017 | amia.org

25. The AFA • The first step is Prioritizing findings to be disseminated via Patient-centered CDS using objective criteria. Some of the important activities at this step include: • Rating the quality of evidence • Rating “implementability” for CDS • Rating the quality impact if implemented • Rating “shelf life” of findings once implemented AMIA 2017 | amia.org

26. The AFA • The next step is AuthoringPCCDS interventions using consensus-enabled data and knowledge standards. At this step standardization becomes a key enabler including: • Standardization of patient data • Standardization of Knowledge representation • Identification and standardization of workflow and insertion points • Standardization of interaction model AMIA 2017 | amia.org

27. The AFA • Once PCCDS is authored, it must be implemented in clinical workflows through standardized methods, and localization to the site, putting in place: • A standard data model • Standard insertion points in workflow • Localization for specific systems and clinical practice norms • Specific mechanisms for curation and feedback from users AMIA 2017 | amia.org

28. The AFA • The next step involves Measuring PCCDS interventions to demonstrate any improvements in clinician and patient decision-making, care processes, and outcomes. Factors to track include: • Process change • Outcomes • Provider and patient user satisfaction AMIA 2017 | amia.org

29. The AFA • To facilitate Learning, clinical, practice, and patient outcomes must be aggregated and fed back into the research process. AMIA 2017 | amia.org

30. The AFA • Finally, Addressing external factors including the marketplace, policy, legal, and governance factors that impact development, dissemination, and implementation of PCCDS is a crucial step in the lifecycle • By organizing our resources and activities around the AFA we offer our stakeholders support at each stage of the process AMIA 2017 | amia.org

31. What Activities Are We Pursuing? • Webinars • Noam H. Arzt, PhD (President, HLN Consulting, LLC), Stuart Myerburg, JD (National Center for Immunization and Respiratory Disease at CDC), Angel Aponte (Division of Disease Control at NYC Department of Health and Mental Hygiene). CDS for Immunizations (CDSi): A Community and Standards-based Approach. January 18, 2018; 1-2pm EST • Upcoming eJournal in collaboration with AcademyHealth (coming March 2018) • Annual PCCDS Learning Network Conference: https://pccds-ln.org/annual-conference • The PCCDS Learning Network Web site: https://pccds-ln.org AMIA 2017 | amia.org

32. https://pccds-ln.org

33. https://pccds-ln.org/resourcecenter

34. Thank you! Email me at: bhb@rti.org

35. Patient Perspective on PCCDS Accelerating Evidence into Practice Session Number 121 Kym Martin, MBA WEGO Health Twitter: @kymlmartin #AMIA2017

36. Disclosure • I disclose the following relevant relationship with commercial interests: • Consultant with WEGO Health AMIA 2017 | amia.org

37. One Story of a Universal Journey Patient Decision Support @kymlmartin AMIA 2017 | amia.org

38. Taxonomy of Burden: Patient Experience Factors that exacerbate the burden of treatment Beliefs Structural factors Treatment characteristics Provider relationships Situational factors Other relationships Personal factors “HCPs don’t trust what I tell them” “My physician doesn’t take into account my context” “I’m a condition, not a person” “HCPs don’t explain things to me” “HCPs don’t consider my psychological problems” “My physicians don’t know my condition” “HCPs neglect some problems for others” AMIA 2017 | amia.org

39. Taxonomy of Burden: Patient Experience Consequences of task burden on patients Healthcare tasks Profound Breadth of Complexity Factors exacerbate burden of treatment Image courtesy of Dave DeBronkart(@ePatient Dave) AMIA 2017 | amia.org

40. Thank you! Email me at: kymm@wegohealth.com

41. AMIA is the professional home for more than 5,400 informatics professionals, representing frontline clinicians, researchers, public health experts and educators who bring meaning to data, manage information and generate new knowledge across the research and healthcare enterprise. AMIA 2017 | amia.org

42. Thank you! Email us at: edwin.lomotan@ahrq.hhs.gov rob@mitre.org bhb@rti.org kymm@wegohealth.com