Next Steps

Specific activities within these 3 prongs are listed below.

I. Enable User-friendly Adoption of the CDS Configuration Template for 10 or More Provider Organizations and Expand the Number of Improvement Imperatives Targeted:

• Engage ten or more additional provider organizations (e.g., clinics, office practices, hospitals, and health systems) interested in replicating within their organization the value realized by pilot sites from documenting and sharing target-focused CDS strategies;
• Develop mechanisms such as a comprehensive Users’ Guide to efficiently enable this engagement and value realization without the weekly meetings and close ‘hand holding’ used to engage sites during the pilot. The guide is a step-by-step manual for how to best leverage the template within an individual organization. It will include instructions for using the guide, the actual CDS/PI configuration template with instructions for applying it and realizing benefits from doing so, and sample presentation decks that organizations have used to present/apply the template;
• Create an electronic fill in the blank version of the template that is more user-friendly. Measure the utility of the tool and template by feedback (e.g., via formal and informal surveys) from organizations applying them in their CDS/PI efforts. Consider revising the tool/template based on user feedback;
• Refine and deploy a next-generation online ‘shared library’ for completed templates. For example, create separate folders for materials related to each improvement imperative. (We will also develop conventions for naming posted files (and consider adding ‘meta-data’ to the files) to help library users from retrieving templates of interest.) The diabetes and VTE materials from the pilot will be separated into such folders, and at least 3 new folders will be created. The folders will contain completed CDS templates from participating organizations, presentation materials that have been used in sharing the templates within an organization. The folder contents will be referenced in online conversations within the Collaborative’s discussion forum (supplemented as needed by periodic phone conferences) where different organizations interested in the same improvement imperative can compare notes, provide peer support, etc. to help each site advance the success and value of their CDS efforts focused on the target. We will analyze discussion forum use and utilize a web tool to track visits to the site in order to characterize and support template use and related discussions;
• Cover at least 2-3 more PI imperatives such as readmissions, early detection of sepsis, other healthcare associated complications (such as catheter-associated urinary and blood stream infections), and other core measures beyond the 2 that were addressed during the Phase 1 pilot (diabetes and VTE). Topics will be selected based on Collaborative participant needs. For each of these additional imperatives, ensure that at least 3 organizations post completed CDS configuration templates for the topic to the shared library;
• Establish forums such as regular target-specific teleconferences and online discussions wherein Collaborative participants can review and accelerate their respective target-focused CDS/PI work. It is anticipated that these would create target-focused ‘collaborative sub-communities’ focused on jointly accelerating local CDS/PI efforts on each topic. Success will be gauged by the number of organizations and individuals that participate in these forums, and their subjective feedback about the value this participation creates;
• Develop and use templates for documenting target-focused CDS/PI project management tasks - and sharing and refining completed templates. Such templates would speak to all the things a provider organization must do to successfully implement a CDS approach to a high priority improvement target. This includes – but is much broader than –intervention configuration details (who, what, when, where, how) that were addressed during the pilot. For example, the management template would include critical success factors for targeted improvements such as how to establish appropriate teams, allocate resources, engage stakeholders, measure and report CDS effects, etc.;
• Explore feasibility and value from organization-specific sub-communities to discuss institution-specific challenges and implementation best practices among facilities in large public and/or private health systems.

II. Deepen and Integrate Engagement of CDS Stakeholders Other than Providers, e.g., Payers, Regional Extension Centers, and EHR and Other HIT/Service Vendors:

• Engage these CDS/PI ecosystem participants more deeply in contributing to and realizing value from the Collaborative. To do this, we will contact them individually and then start to speak to them in inter-connected groups about joint value propositions;
• Engage EHR/HIT vendors more deeply in providers’ CDS strategy documentation and sharing to ensure that their tools are used most effectively in PI efforts – e.g., by creating vendor-focused Collaborative sub-communities. As these communities evolve, it is likely that we would create vendor specific adaptations of the CDS configuration template (complementing the vendor-neutral version) to match the process flow and capabilities of specific EHR systems;
• As a component of cross-stakeholder conversations, explore developing a CDS/PI value delivery pilot involving payers, Regional Extension Centers, providers, and EHR vendors (consider California-based opportunities for doing this).

III. Develop a Sustainability Plan for Maintaining an Enhancing the Collaborative:

• Create a Collaborative Sustainability Plan. This involves identifying mechanisms for making the Collaborative self-sustaining based on work performed as part of prongs 1 and 2. The plan includes making the collaboration activities self-perpetuating (e.g., via Users’ Guide and related approaches to systematize steps in the Collaborative’s value delivery process), as well as creating a plan for ongoing funding in return for value delivered to stakeholders.