CDSC: Cloud-Based Decision Support - YouTube

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Narrator: CDSC: Cloud Based Decision Support

Jon White: I'm Jon White, Director of the Health IT Portfolio

and The Agency for Healthcare Research and Quality, or AHRQ.

AHRQ funds projects that demonstrate how health IT

can improve the quality of healthcare for all Americans.

In 2008, AHRQ funded two large demonstration projects

that explored how to create high-quality clinical decision support,

or CDS, and deliver it at scale to the point of care

around the nation. At the Brigham and Women's Hospital

in Boston, Dr. Blackford Middleton and his team,

the Clinical Decision Support Consortium,

demonstrated how their model can benefit providers

of different types and sizes, using different EHRs

at locations around the country.

William Lucas, MD: We are in a rural area.

We're in a small town here, but it's even more rural

the further away you get from us.

And the closest facility is probably Salem,

about 25 miles away, which isn't completely out of reach.

But it's a long time to hold your breath

if you're having trouble breathing.

Gregory Fraser, MD: Science is growing at a,

at a rate which really is beyond the human brain's capacity.

And this is why I believe we need computer systems;

we need a second brain, if you will,

to kind of help us with some of this stuff.

Blackford Middleton, MD: When you look at how long it takes knowledge

to be brought into routine practice

it can be as long as 17 years.

So one of our goals was to short circuit

that inordinately long time frame

and make new knowledge available to practitioners

as soon as it's ready and validated for use.

William Lucas, MD: In family medicine there's really nothing

that's off the table.

It's not like specialty care where I can kind of assume that

if someone came to me, and I'm a pulmonologist,

that this likely has to do with their lungs.

We're the guys that do the sorting out and

kind of unravel the puzzle

and kind of figures out what category it falls in,

So sometimes you're surprised by things

that maybe you just haven't seen in a long time or potentially never.

If I could have a popup that's about three paragraphs long

that I can read in a minute and a half or less in the exam room

while I'm talking to a patient once I decide what's going on.

That to me would be extremely useful.

Narrator: In pursuit of this goal,

the CDS Consortium used a four-stage approach to clinical decision support.

The first step was to identify, or develop,

a guideline to describe a specific clinical best practice.

Next, key rules and logical statements were abstracted.

This logic was used to develop computer code for CDS rules.

And finally, a web service was created to deliver these CDS

rules to multiple different EHR systems nationwide.

Blackford Middleton, MD: The biggest challenge that we had to address

was how to deliver this knowledge across thousands of miles

to the point of care from Boston.

Narrator: For that, the CDS Consortium partnered with EHR vendors

and medical practitioners

in locations around the country.

Blackford Middleton, MD: Dr. Greg Fraser at WVP Clinic in Oregon

was able to work with us to implement these cloud-based services.

Gregory Fraser, MD: We're an independent physicians association

for about 520 doctors in the Marion and Polk county area in Oregon.

The majority of our member practices are very small.

Ninety percent of them are four doctors or less,

they're very independent.

We administer a community electronic health record for a number of,

of offices and we're a fairly sizeable client for our EHR vendor.

Well the process of implementing the CDSC

demonstration project for us was one of collaboration

between Partners Health Care, between the EHR vendor and us.

We had to create about three dozen test patients and we gave

them very specific clinical profiles in their test medical records.

There were 11 clinical rules that we were testing.

They were related to diabetes and coronary artery disease and

blood pressure measurement.

And so we would have situations where the clinical rules engine

wasn't recognizing the last time the patient had an hemoglobin a1C test,

even though we knew it was in there.

Well, why not?

I met with the doctors and asked them to participate and I

communicated with them electronically to say okay,

we're turning it on, If you see this button,

click on it, look at what's there,

let me know whether it's useful or not.

And for sure let me know if you see anything that looks wrong.

William Lucas, MD: The CDS had a small button in the upper left corner.

If an individual had a medical problem that applied

to the two tools that CDS implemented, in this case

coronary artery disease antiplatelet therapy and diabetes,

then information would be within that popup window

when you clicked the button.

The information that was provided within the button when

you did click it for the appropriate patient was useful information.

It did apply to the individual patient.

Gregory Fraser, MD: Well, what we heard from the,

from the providers that were participating in this is that

actually some of them really liked what we were presenting to them.

They just kept saying to me, well, I wish there was more.

William Lucas, MD: There's such a huge volume of information

coming out all the time that it's nice to have kind of a set guideline

or a backbone of information that it gives you a starting point.

Patient: At first I thought it was a distraction.

I didn't feel like I was being paid attention to.

But now I don't feel that way.

It was just getting used to a different way of doing it,

because I can see how much more information they can get

by doing it that way.

Blackford Middleton, MD: Clinical decision support is not cookbook medicine.

The best kind of decision support is watching and behind

your back providing oversight or guidance for you when you need it.

The CDS Consortium achieved the ability to deliver decision

support across thousands of miles by putting these decision

support methods into web services that can be delivered

over the Internet in real time.

EMRs made by different vendors have different methods and

operations and procedures in how they handle decision support and

encode knowledge for decision support in those systems.

The fact that we can provide from Boston via the cloud the

same decision support to multiple different EMRs

was a significant achievement we believe.

It's never been done before.

Narrator: If you'd like more information on the CDSC project

or others like it, look on the AHRQ website

and use the search term: Clinical Decision Support.

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