CDS Meets QDM

by Karl Gumpper, RPh, BCPS, FASHP, Member, HIMSS NQF Task Force

With the use of electronic health records, we have a great opportunity to collect and share patient data to better care for a single patient or a population of patients. The National Quality Forum convened an Expert Panel to develop a clinical decision support (CDS) taxonomy that could work with the Quality Data Model (QDM) to capture and report specific quality outcomes data.

The expert panel’s report, “Driving Quality and Performance Measurement—A Foundation for Clinical Decision Support ” describes this effort.

Building upon and leveraging existing CDS taxonomy efforts, the Expert Panel agreed to use a taxonomy developed at Partners HealthCare, Inc. (Partners) as a starting point for the NQF CDS Taxonomy. Taxonomy is composed of four functional categories that classify and categorize the CDS information necessary for quality improvement:

• Trigger: events or actions that initiate a CDS rule
• Input Data: the additional data, from the patient record or other source, used as background to modify or constrain the CDS rule
• Interventions: the possible actions taken by decision support to provide information when the conditions specified in a rule are met
• Action Step: any action or event presented to the user of a clinical system that could lead to successful completion (or realization) of the intended mission of the rule

The Expert Panel developed the following recommendations for NQF’s work and validation of the CDS Taxonomy for use across various healthcare settings:

• continue development and refinement of the CDS Taxonomy;
• incorporate the CDS Taxonomy, using the QDM, in real settings that implement CDS;
• educate NQF members and the public on the value and impact of CDS and the NQF CDS Taxonomy;
• work to incorporate the NQF CDS Taxonomy into other ongoing quality and CDS efforts to further the linkage between clinical care, quality measurement, and performance; and
• facilitate sharing across NQF members and key stakeholders regarding application of CDS tools, the NQF CDS Taxonomy, and the QDM to real-world implemen­tations of CDS to improve quality.

Incorporating CDS into the clinical workflow in a seamless and intuitive fashion is an on going battle with EHR implementations. Alert fatigue and disruptive alerts that do not bring value to the patient’s provider need to be addressed.

The power of CDS in prompting and capturing data to gain quality data will be of greater importance as new care delivery models are developed. As guidelines are developed and eMeasures are created, the use of CDS in capturing the data for providers will be important. Collection of this data will occur behind the “scenes” and will enable providers to better care for their patients without just clicking through a bunch of “pop-ups.”

We have a ways to go with CDS, but I am hopeful that we are moving the right direction and able to use a common vocabulary to determine what works and where improvements may be discovered.

Karl Gumpper, RPh, BCPS, FASHP                                                                                          Director, Section of Pharmacy Informatics & Technology
American Society of Health-System Pharmacists®