A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties

Table 8 Classification of performance gaps and CDS opportunities based on median ratings and statistical agreement, by rating criterion

	Rating Criterion	Rating result
		Median: 1-3 AND No Disagreement*	Median: 4-6 OR Disagreement	Median: 7-9 AND
		Median: 1-3 AND No Disagreement*	Median: 4-6 OR Disagreement	Indeterminate Agreement	Agreement**
Performance gaps	Importance	Unimportant	Equivocal	Important	Important – highest priority
CDS opportunities	Compatibility	Incompatible with clinical practice	Equivocal	Compatible with clinical practice	Compatible with clinical practice – highest priority
CDS opportunities	Potential impact	Low potential impact	Equivocal	High potential impact	High potential impact – highest priority

*“No disagreement” implies either “agreement” or “indeterminate agreement”.
**While the RAND/UCLA Appropriateness Manual (RAM) only requires median ratings in the 7-9 range and the absence of disagreement to classify items as high priority, we used a higher bar, by requiring that each criterion exhibit statistical agreement. Items with indeterminate levels of agreement were not considered high priority.

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