HIMSS CDS Guidebook Excerpts

The tasks, key lessons, worksheets, and key considerations below are part of the HIMSS CDS Guidebook titled, Improving Outcomes with Clinical Decision Support: An Implementer’s Guide. The information below will help guide you in understanding foundational considerations for effective CDS interventions.

Chapter 2

Tasks

• Determine and document the CDS program approach and activities, addressing key dimensions including why, what, how, who, and when. (Worksheets 2-1, 2-2)
• Integrate the CDS program with overall operations governance, and especially with quality and HIT planning and execution.
• Document a plan for prioritizing CDS-mediated improvement goals, based on internal/external drivers (e.g. Meaningful Use, Patient Centered Medical Home Certification, clinical quality measures, value-based purchasing). (Worksheets 2-1, 5-1)
• Establish CDS Team, including clinical champion(s), technical resources and administrative support. Ensure availability of staff, consultants, and/or vendor personnel to fill essential roles needed for CDS program success, including those related to program governance as well as intervention design, development, implementation and evaluation.
• Approach CDS as a shared effort with intervention recipients as part of a collaborative improvement culture. Engage all key stakeholders in the CDS program in a way that each recognizes personal advantages from the CDS activities.
• Establish oversight and communications mechanisms for key strategic and tactical decisions and activities, such as initiating, deploying and monitoring CDS interventions to achieve priority goals and objectives. (Worksheet 2-2)
• Identify primary champions representing “a collection of respected figures in various positions, such that everyone else will listen to at least one of them” and richly engage them in processes related to CDS program and intervention development.
• Consider how you will measure and report CDS program results, and address these issues in your CDS program charter as appropriate.

Key Lessons

A comprehensive CDS Program should include all of the following to ensure success:

• Support for the program comes from all levels of the organization.
• Key stakeholders are involved.
• A clinically oriented leader guides the effort and is able to form an effective bridge between improvement requirements and system and organizational capabilities.
• A multidisciplinary CDS committee includes supporters and potential resistors because CDS is a “team sport” regardless of size or type of organizations.
• CDS program goals are aligned with strategic goals of the organization.
• There’s an ongoing commitment to bi-directional communication about the CDS efforts with all levels of the organization.
• The target audience for CDS interventions and other stakeholders are involved and engaged: do CDS with them and not to them.
• There are staff and mechanisms in place to ensure strong support and rapid problem resolution before, and especially during, early intervention implementation.
• There is emphasis on measuring CDS program effects in an ongoing fashion from the earliest stages of program development; this is necessary to make the program’s value clear and compelling to stakeholders, and to enhance this value over time over time.

Worksheets

You can find the corresponding worksheets for this chapter here:

2-1a: Stakeholders, Goals, and Objectives

2-1b: Worksheet 2-1a continued

2-2a: Checklist for Clinical Decision Support Goal Charter

2-2b: Worksheet 2-2a continued

5-1: Selecting and Prioritizing CDS Goals

Chapter 2 HIMSS Considerations - Small Practices

Chapter 2 HIMSS Considerations - Vendors

Chapter 5

Tasks

• Solidify your organization’s foundational understanding of CDS concepts, including the ‘CDS Five Rights’ framework, to prepare for choosing and configuring CDS interventions.
• Narrow the high-level improvement goals identified in Chapter 2 (Worksheet 2-1), selecting those that have the most organizational support and are most likely to succeed. Start small and build to more complex goals with experience. (Worksheet 5-1)
• Identify specific CDS objectives to achieve each high level goal. From these objectives, choose those that have the highest potential for impact and for which CDS interventions will be most practical and effective. Gather baseline data about performance on selected objectives, and work closely with stakeholders on all these activities. (Worksheets 5-1 through 5-4)
• Familiarize yourself with the wide range of CDS intervention types. Keep these in mind as you select your objectives, recognizing that any objective may be addressed through a single CDS intervention or through a package of interventions.

Key Lessons

• The CDS Five Rights approach provides a framework for considering the what, who, how, where, and when dimensions in configuring effective CDS interventions. This framework should underpin the CDS team’s efforts, including collaboration with stakeholders.
• For many important objectives, using more than one CDS intervention (a CDS package), triggered at different points in the clinical workflow for different end user types, will produce a greater impact.
• CDS interventions can be grouped into ten different types. Understanding these intervention types, their advantages and disadvantages, and how they can work together to optimize care processes, is critical in selecting and designing optimal CDS approaches to accomplish specific objectives.
• There are several steps in the CDS intervention lifecycle after determining which goals and objectives to address; these include selecting, configuring, vetting, testing, implementing, and measuring effects. We delve into these in greater detail in subsequent chapters.

Worksheets

You can find the corresponding worksheets for this chapter here:

2-1a: Stakeholders, Goals, and Objectives

2-1b: Worksheet 2-1a continued

5-1: Selecting and Prioritizing CDS Goals

5-2a: Objectives to Achieve Goals

5-2b: Worksheet 5-2a continued

5-3a: Roles and Responsibilities of Clinical and Non-clinical Stakeholders

5-3b: Worksheet 5-3a continued

5-4: Linking Systems and Objectives

Chapter 5 HIMSS Considerations - Small Practices

Chapter 5 HIMSS Considerations - Vendors

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