Difference between revisions of "Key principles for a national clinical decision support knowledge sharing framework synthesis of insights from leading subject matter experts"

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(Created page with "This is a review for Raghupathy Anchala, MD, PhD, Stephen Kaptoge, PhD, Hira Pant, MA, Emanuele Di Angelantonio, MD, PhD, Oscar H. Franco, MD, PhD, and D. Prabhakaran's, MD, D...")
 
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This is a review for Raghupathy Anchala, MD, PhD, Stephen Kaptoge, PhD, Hira Pant, MA, Emanuele Di Angelantonio, MD, PhD, Oscar H. Franco, MD, PhD, and D. Prabhakaran's, MD, DM, MSc Creating Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial.<ref name="Anchala 2015"> Raghupathy Anchala, MD, PhD, Stephen Kaptoge, PhD, Hira Pant, MA, Emanuele Di Angelantonio, MD, PhD, Oscar H. Franco, MD, PhD, and D. Prabhakaran's, MD, DM, MSc Creating Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial. J Am Heart Assoc. 2015 Jan 5;4(1):e001213. doi: 10.1161/JAHA.114.001213. http://www.ncbi.nlm.nih.gov/pubmed/25559011</ref>
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This is a review for Kensaku Kawamoto, Tonya Hongsermeier, Adam Wright, Janet Lewis, Douglas S Bell, Blackford Middleton’s Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts <ref name=" Kawamoto 2013"> This is a review for Kensaku Kawamoto, Tonya Hongsermeier, Adam Wright, Janet Lewis, Douglas S Bell, Blackford Middleton’s Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts. J Am Med Inform Assoc. 2013 Jan 1;20(1):199-207. doi: 10.1136/amiajnl-2012-000887. Epub 2012 Aug 4. http://www.ncbi.nlm.nih.gov/pubmed/22865671</ref>.
  
  
 
== Introduction ==
 
== Introduction ==
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The Office of the National Coordinator for Health IT (ONC) has expressed interest in promoting a way for the United States healthcare industry to share various Clinical Decision Support ([[CDS]]) knowledge.  
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In the western world, Clinical Decision Support ([[CDS]]) has proved to be successful in helping doctors treating and managing hypertension (HTN) patients, however there is not much information on how effective a CDS system would be in a developing country. India is currently experiencing a strong need for more providers in the Primary Health Care (PHC) setting and are also experiencing an increase in healthcare IT available. Therefore there is a chance to get some more insight of how effective CDS could be in lower-income countries at aiding in managing hypertension.  
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== Methods ==
 
== Methods ==
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PHC physicians in India were randomized to receive the Decision Support System (DSS) or Chart-based Support (CBS).  
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Various stakeholders of potential CDS knowledge sharing were identified. These stakeholders included EHR vendors, clinical content vendors, healthcare organizations, and clinical informatics subject matter experts. Emails were sent to these identified persons to participate in sharing their thoughts on how and if this CDS knowledge sharing would look like. 19 shareholders agreed and were given initial surveys. After the surveys were collected, the 19 participating stakeholders were further interviewed for further discussion.  
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The Decision Support System (DSS) is a software that was previously created to help physicians evaluate and classify their patient’s risk factors of developing Cardiovascular disease, calculate and provide drug-management guidelines and alert the physician to counsel the patient on behavioral changes.
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The Chart-based Support (CBS) is the same guidelines as those integrated in the DSS software, but printed on a poster and hung where the physician met with his/her patients.  
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The DSS and CBS Physicians’ patients who gave consent, were between 35 to 64 years old and had a systolic blood pressure (SBP) of 140+ mm HG and/or diastolic blood pressure (DBP) of 90+ mm HG were included in this study. The both sets of participants’ data was collected and the SBP at 0 and 12 months were compared.  
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In order to calculate both the DSS’s and the CBS’s cost-effectiveness, the authors used Drummond’s 10-point check list.
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== Results ==
 
== Results ==
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According to the authors’ results, the physicians using the DSS agreed with the DSS suggestions 93% of the time during the study.  
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The authors abstracted five main themes from the feedback of the 19 stakeholders:
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The unadjusted mean SBP for the DSS group was calculated for both groups at 0 months and 12 months:
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1. Prioritize and support the creation and maintenance of a national CDS knowledge sharing framework
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* DSS Group 0 months: 151.1 | CBS Group 0 Months: 148.2
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2. Facilitate the development of high-value content and tooling, preferably in an open-source manner
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* DSS Group 12 Months: 139.9 | CBS Group 12 Months: 144.7
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3. Accelerate the development or licensing of required, pragmatic standards
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The unadjusted mean DBP for the DSS group was calculated for both groups at 0 months and 12 months:
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4. Acknowledge and address medicolegal liability concerns
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* DSS Group 0 months: 89.7 | CBS Group 0 Months: 88.4
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5. Establish a self-sustaining business model
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* DSS Group 12 Months: 84.3 | CBS Group 12 Months: 86.3
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The cost-effectiveness ratio (CER) for the DSS group was $36.57 per mm reduction in SBP and the CER for the CBS group was $96.01 per mm reduction in SBP.
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== Discussion ==
 
== Discussion ==
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A significant improvement was seen in the DSS group for both the unadjusted mean SBP, but the improvement for the CBS group was less significant. This improvement is more significant than previous DSS studies and the authors attribute this to the shortage of providers in PHC settings and specialization of the DSS.  
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Although not everyone in the healthcare industry was included in the stakeholder survey or interviews, the ones that were involved make up a big chunk of the market share. Since these participants are influential in the healthcare world, the ONC should use these findings as a guideline in their work to establish a CDS knowledge sharing framework.  
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== Commentary ==
 
== Commentary ==
  

Revision as of 00:34, 25 March 2015

This is a review for Kensaku Kawamoto, Tonya Hongsermeier, Adam Wright, Janet Lewis, Douglas S Bell, Blackford Middleton’s Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts [1].


Introduction

The Office of the National Coordinator for Health IT (ONC) has expressed interest in promoting a way for the United States healthcare industry to share various Clinical Decision Support (CDS) knowledge.

Methods

Various stakeholders of potential CDS knowledge sharing were identified. These stakeholders included EHR vendors, clinical content vendors, healthcare organizations, and clinical informatics subject matter experts. Emails were sent to these identified persons to participate in sharing their thoughts on how and if this CDS knowledge sharing would look like. 19 shareholders agreed and were given initial surveys. After the surveys were collected, the 19 participating stakeholders were further interviewed for further discussion.

Results

The authors abstracted five main themes from the feedback of the 19 stakeholders: 1. Prioritize and support the creation and maintenance of a national CDS knowledge sharing framework 2. Facilitate the development of high-value content and tooling, preferably in an open-source manner 3. Accelerate the development or licensing of required, pragmatic standards 4. Acknowledge and address medicolegal liability concerns 5. Establish a self-sustaining business model

Discussion

Although not everyone in the healthcare industry was included in the stakeholder survey or interviews, the ones that were involved make up a big chunk of the market share. Since these participants are influential in the healthcare world, the ONC should use these findings as a guideline in their work to establish a CDS knowledge sharing framework.

Commentary

In this article, the authors wanted to shed some light on the effectiveness of a CDS system in low to middle income countries. While I think this is interesting, this study only included one country’s result and I would caution not to base all low-middle income countries on these results.

References

  1. ↑ This is a review for Kensaku Kawamoto, Tonya Hongsermeier, Adam Wright, Janet Lewis, Douglas S Bell, Blackford Middleton’s Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts. J Am Med Inform Assoc. 2013 Jan 1;20(1):199-207. doi: 10.1136/amiajnl-2012-000887. Epub 2012 Aug 4. http://www.ncbi.nlm.nih.gov/pubmed/22865671
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