Pilot Project Description

• To develop and test a process for documenting and sharing CDS intervention approaches. Specific tasks included:Refining a published structured template for documenting and sharing CDS intervention configurations[1];
• Developing an approach to using the template in care delivery organizations (CDOs) and getting benefit from it;
• Pilot testing the template in several CDOs, with each completing it for the same inpatient or outpatient improvement imperative (based on their consensus choice of inpatient and outpatient targets on which to focus);
• Assessing the value realized by participants from completing the template, examining the results of the other organizations, and using this information in their local performance improvement efforts;
• Developing an approach to subsequently scale this exploratory effort – and the value it generates - to many other care delivery organizations and additional performance improvement targets.

Image by Sheela Mohan / Free Digital Photography.net

Pilot Participants

• Inpatient (target=VTE Prophylaxis)
  • Ascension/St John Providence Health System (Cerner)
  • Hennepin County Med Ctr (Epic)
  • Lehigh Valley Health Network (GE)
  • MetroHealth System, Case Western Reserve U. (Epic)
  • New York Hospital, Queens (AllScripts)
  • Texas Health Resources (Epic)
  • University of Pennsylvania (Allscripts)
• Outpatient (target=Diabetes Management)
  • University of Pennsylvania (Epic)
  • Veterans’ Administration (Homegrown)

Pilot Project Outcomes

Based on a survey conducted at the completion of the pilot study, the outcomes are summarized below; further details in the document at the bottom of this page:

• 8 of 9 sites* reported using the template was somewhat to significantly useful for local stakeholder engagement, CDS/PI strategic planning, and/or CDS implementation
• All 9 sites reported that the net project effect on their organization’s CDS/PI efforts was either 'somewhat helpful' or 'significantly helpful'
• 8 sites anticipate continued use of the template in their organization**
• All 9 sites indicated that they would like to continue to participate in the Collaborative

*1 site did not have an active PI project focused on the target addressed by the group

**9th site would use the template if there were a large group sharing completed templates

Pilot Activities/Approaches

To achieve these objectives, we employed the following activities/approaches:

· Established a broad-based collaborative with staff from healthcare delivery organizations, EHR and other HIT vendors, federal agencies, and others to guide the project’s activities;

· Refined, with input from Collaborative participants, the guidebook-based template for documenting CDS configurations in a structured manner;

· Recruited 9 CDOs to complete the CDS configuration template; 7 focused on an inpatient PI imperative and 2 focused on an ambulatory target;

· Achieved consensus on targets (one each for inpatient and outpatient settings) of interest to pilot test sites on which to focus initial CDS configuration documentation and sharing efforts. Venous thromboembolism (VTE) prophylaxis for hospitalized patients and improving outpatient diabetes management (for example, by using CDS to ensure that all diabetic patients receive HbA1c screening at regular intervals, and that abnormal results are attended to appropriately) were the initial targets selected;

· Tested the structured template by having pilot sites document their respective CDS configurations for the selected improvement objectives, discusssing CDS configurations across organizations, and documenting the benefits and limitations of using this information in their respective performance improvement efforts;

· Reviewed pilot results with the broader Collaborative and developed consensus recommendations on next steps. For example, fostering broader engagement in - and value from - this effort;

· Produced a project report summarizing results with a focus on preliminary implications for:

o CDS implementers regarding use of the template;

o EHR vendors on how to help their clients better leverage their systems to improve key outcomes;

o Federal agencies on how initial results can support policies and performance improvement initiatives; and

o Others that surfaced as important during the initial work.

· Developed initial strategies or approaches for scaling the project work across additional care delivery organizations and other high priority improvement targets.

Additional Pilot Evaluation/Measurement

The pilot participants, leadership and sponsor (CHCF) consider the pilot a success based on the survey results listed above and the following:

· The number of sites that participated as pilots (i.e., 9 when only 4 where planned), and the speed and eagerness with which they joined the effort;

· The rapid consensus about imperatives on which to focus joint efforts;

· The refinement and adoption of a consensus template for documenting and sharing CDS configurations;

· The speed and magnitude of the local value realized from these efforts;

· The intention by all but one pilot site to continue using the template after the pilot concluded [The 9th site said they would use it if there were many other sites completing the template and sharing results];

· Positive feedback from pilot site participants, members of the collaborative, and other key stakeholders, about the value of this initiative to their efforts [see this document for survey result details];

· During the pilot, many additional provider organizations and other stakeholders joined the initiative, and some began using the template in their efforts.

Subsequent Collaborative Steps

CHCF provided an additional year of seed funding to scale the initiative, further cultivate cross-stakeholder collaboration, and develop a sustainability plan. Results from the 1.5 years of CHCF Collaborative seed funding are described in this slide deck. Current Collaborative tools and activities are described in other pages on this site.

[1] The starting point for refining the CDS configuration template used in the pilot was two worksheets from the Improving Outcomes with Clinical Decision Support: An Implementer's guide. Second Edition. HIMSS, 2012. The worksheets are based on the CDS 5 RIghts framework, that outlines what information is delivered to which recipient in what intervention format through which channel at what point in workflow. The worksheets include prompts about configurations for the other elements that are pertinent at each workflow step. They were further refined and enhanced under an ONC CDS/QI project, and the latest versions are here.