P0028 - Revising Shareable Clinical Decision Support (CDS) to Integrate New Guidelines While Promoting Dissemination

Background: Our organization developed Clinical Decision Support (CDS) for new refugee patient management utilizing a process with stakeholder group input, including feedback from 19 institutions. This module, published through CDS Connect, was implemented by 2 sites reporting 30-hour build times. Other interested sites could not expand their resources for implementation, citing a 10-hour build time maximum. We sought to modify the CDS to support new CDC guidelines while streamlining to a 10-hour build time (Lite Version) to facilitate dissemination for community hospital and public health settings.

Objectives: Update CDS to reflect changes in underpinning guidelines and streamline to a goal 10-hour implementation time.

Methods: We obtained all guideline documents as they were published by the Centers for Disease Control and Prevention (CDC) on the CDC’s website. Each newly guideline was compared to the previous version to determine if the recommendations from the previous versions were retained, modified, omitted, or newly inserted. The content comparisons were reviewed for accuracy by clinical content experts and an informaticist familiar with the original build.
To streamline to a Lite Version, we evaluated original build components, considering clinical relevance and the time required to build and provide future maintenance. We developed time estimates for each build section and overhauled our implementation guide. We selected a pilot site, while testing adjustments to the build and guide.

Results: Most of the guideline recommendations were clinically unchanged from the old guidelines. Certain recommendations from the old documents were no longer included, many of these due to restructuring of reference materials and attempts to align with other CDC guidance. Several new recommendations, and one entire new guideline, were noted and the material was extracted for implementation within the CDS. All guideline directed recommendations were incorporated into the CDS and the Lite Version.
For supporting a proposed Lite Version, we reduced our technical documentation from 104 pages to 30 pages and our set of build elements from 387 to 83. We eliminated all but two of the research/registry reporting components, decreased the number of age- and gender-based documentation templates and order groups, and simplified all documentation templates. Finally, we removed all use advanced CDS programming functionality, based on the feedback from previous implementing sites that were unfamiliar with these tools. A comparison of components in the original and lite version are included in Table 1.

Conclusion: CDS developed for sites must be adjusted to support widespread inclusion and can be adjusted while updating content with new guidance. Tradeoffs to consider include reporting functions, fine tuning of order groups and documentation templates, and advanced CDS programming functions.