We were tasked by the Office of the National Coordinator for Health Information Technology (ONC) with developing a framework for eliciting high-priority targets for clinical decision support (CDS) for clinical specialties that could inform the establishment of CDS meaningful use (MU) objectives. This chapter describes the prototype methodology we tested with four clinical specialty panels, detailing the following:

conceptual framework for specifying high-priority targets for CDS based on clinical performance gaps and CDS opportunities

composition of each specialty panel and the process used to identify candidates

approach used to identify candidate performance gaps for each clinical specialty

approach used to...

Oncology was selected as a specialty to test the draft protocol due to its rapidly evolving evidence base; the diversity of its workflows, which include managing transitions between settings and coordinating therapies and management with other specialists; treating different phases of illness; and the complexity of treatment protocols. Oncology workflows are unique in several ways, and that fact has posed a challenge for EHR vendors to adapt their systems to support oncology workflows. Chemotherapy administration involves multiple orders for intravenous medications with complex rules regarding infusion volume, rates, and order of administration, which are bundled together with supportive care drugs,...

The panel’s designated clinical focus was total knee replacement surgery and total hip replacement surgery. Panelists were nominated by AAOS based on their expertise in some combination of total joint replacement, health IT, quality management, and epidemiology or outcomes research in orthopedics. All panelists were board-certified orthopedists. Seventeen panelists completed participation, and two others withdrew after participating in the initial rating steps.⁶ Table 3.1 categorizes the panelists according to their expertise. Additionally, two of the members had current expertise with orthopedics in small practice environments.

The panel rated a total of 28 performance gap statements that had been nominated by...

The pediatrics panel was designed to elicit CDS MU targets for children and adolescents who are typically treated in primary care settings. Unlike our approach for the oncology and orthopedic surgery panels, we placed few restrictions on the clinical focus of the pediatrics panel with one exception: We focused on conditions that were most likely to be managed by general pediatricians rather than pediatric specialists. Thus, although numerous quality measures have been developed in the areas of childhood cancers, pediatric end-stage renal disease (ESRD), pediatric HIV, and pediatric gastroenteritis, to name a few, we excluded these conditions because they might...

The PCI panel was constructed, in part, to determine whether condition-specific or procedure-specific panels might also be more useful for eliciting CDS targets than panels defined according to specialty. For this panel, we focused on the management of both ACS and stable CAD. Because this was our only condition-specific panel, we sought input from a wide range of specialties, including interventional and noninterventional cardiologists, as well as internists and electrophysiologists.

At the outset, the panel was made up of 15 physicians, including two panel co-chairs. Thirteen of the panelists completed all ratings. Table 5.1 provides a breakdown of the panelists...

The federal MU incentive program for health information technology (HIT) includes CDS as a central feature for improving health outcomes; however, a process for identifying and selecting the most promising targets for CDS has not been established. To define requirements for CDS to support MU of EHRs, ONC faces a challenging set of demands. ONC is being asked to drive implementation of EHRs on a rapid timeline and to do so in a way that improves both clinical quality and population health outcomes. To accomplish these goals, ONC is being asked to engage health care providers and other stakeholders in...