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AMIA Annu Symp Proc. 2012; 2012: 1–2.
Published online 2012 Nov 3.
PMCID: PMC3540448

The Practice of Clinical Decision Support: Applying Standards and Technology to Deliver Knowledge-Driven Interventions

Robert A. Jenders, MD, MS, FACP, FACMI,1,2 Guilherme Del Fiol, MD, PhD,3 and Kensaku Kawamoto, MD, PhD3
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Abstract

Clinical decision support (CDS) delivered in the context of electronic health record systems is receiving increasing attention as a way to help improve clinical practice and health behaviors. Nevertheless, multiple technologies exist to implement and maintain CDS, and there is little consensus on their use. The use of health information technology (HIT) standards for encoding data, representing knowledge and delivering knowledge-based interventions can help facilitate implementation of CDS. However, many standards from numerous standards development organizations (SDOs) exist that are variously incorporated into vendor software, and consensus on the use of these standards is lacking.

Accordingly, the purpose of the presentation is twofold. First, the presenters, who are co-chairs of the Health Level Seven CDS Work Group, will survey the state of the art and science regarding HIT standards that are applicable to CDS. In this analysis of the standards landscape, the presenters will emphasize those standards concerning knowledge representation and delivery as well as convey the latest developments regarding these standards and related efforts to develop new standards. Second, the presenters will show how this work has been translated into software tools and actual implementations that are used to deliver knowledge interventions and to provide CDS.

Description

The presentation will consist of two themes. The first theme will address the development of standards for knowledge representation and related standards such as standard data models and ontologies. In this part, the presenters will describe the latest versions of standards such as the Arden Syntax, GELLO, Decision Support Service and Infobutton standards. They also will discuss related work on proposals for new standards: clinical guidelines, quality indicators and order sets. This will include a description of efforts to harmonize the data model and expression languages among these formalisms, such as the Health Level Seven (HL7) Virtual Medical Record (vMR) standard. The instructors will describe related efforts in other standards development organizations (SDOs), including the Object Management Group (OMG) and ASTM International, as well as work being conducted via the Joint Initiative Council (JIC) for global health informatics standardization. The context for these efforts, including public policy and collaborative projects that promote CDS, will be described. The second theme will elaborate how these standards are incorporated in implemented health information systems to facilitate the delivery of CDS.

The presenters are co-chairs of the HL7 CDS Work Group, the premier SDO for HIT. They will present the details of the latest work in HL7 and other SDOs related to CDS as well as solicit feedback that will help improve the formulation of these standards and their use in practice.

Outline of Topics

  • Synthesis of the literature of the state of the science for CDS practice.
  • Overview of the purpose, format and use of current CDS-related standards, including the HL7 Infobutton standard, the HL7 Arden Syntax, the HL7 Decision Support Service standard, the HL7 GELLO standard, and the HL7 vMR standard. CDS-related standards from other SDOs also will be addressed.
  • Discussion of future plans for CDS and related standards.
  • Description of software and projects that leverage CDS standards to deliver knowledge-based interventions in a scalable manner, such as the OpenCDS initiative (www.opencds.org), the OpenInfobutton initiative (www.openinfobutton.org), and commercial implementations of the Infobutton standard.
  • Discussion of international harmonization efforts being conducted through HL7, the JIC and elsewhere.
  • Highlights of the role that CDS standards play in national and international initiatives, such as Meaningful Use and Health eDecisions in the USA.
  • Solicitation of feedback regarding the continued development and implementation of CDS standards.

Educational Goals

  1. Participants will become familiar with the basic purpose and structure of CDS standards such as the HL7 GELLO standard, the HL7 Arden Syntax standard, the HL7 Decision Support Service standard, the proposed HL7 Order Set standard, the HL7 Infobutton standard, the HL7 Health Care Quality Measure Format standard, and the HL7 vMR standard.
  2. Participants will learn the plans for and ongoing work related to CDS standards.
  3. Participants will understand how these standards are incorporated in actual implementations and how they may be leveraged to deliver CDS.
  4. Participants will learn about open-source tools and resources that can be leveraged to implement standards-based CDS interventions.
  5. Participants will have the opportunity to contribute ideas for improving CDS standards.
  6. Participants will learn about efforts to harmonize CDS standards across various SDOs.

Who Should Attend

  1. Clinicians interested in using or learning more about CDS systems.
  2. Developers of CDS systems.
  3. Workers interested in communication and related health data and knowledge representation standards such as those sponsored by HL7 and other SDOs.
  4. Practitioners facing the challenges of system interoperability and meaningful use of electronic health record systems.
Articles from AMIA Annual Symposium Proceedings are provided here courtesy of American Medical Informatics Association