Table 4 CDSC recommendations for CPG development activities
From: Beyond the threshold: real-time use of evidence in practice
# | Recommendation | Description | Rationale |
|---|---|---|---|
1 | Identify standard data triggers | Guidelines should explicitly identify clinical or administrative data required to initiate any of the CDS interventions included in the guideline | Required data need to be captured and stored in structured and coded fields in order to be utilized by CDS systems |
2 | Review Access to Existing Input Data | Commonly available input data for use by CDS logic (e.g., for alerts) include: laboratory test results, patient demographics, and the problem list. CPGs should specify only specify coded data types which are currently or soon will be available in certified EHRs | Input data that are not available in certified EHRs will results in guidelines that cannot be incorporated in a computable manner within EHRs |
3 | Work on increasing clarity and internal consistency of all clinical logic included in guidelines. | CPGs should minimize the ambiguity of their recommendations (e.g.,include threshold values for blood pressure rather than stating “if the patient’s blood pressure is high then…” ). | Logic in CPGs must be able to be incorporated in a computer executable form |
4 | Suggest appropriate personnel and best insertion points in the clinical workflow for CDS interventions to be delivered | CPGs should specify how the EHR can route recommend actions to the appropriate person or role, at the right time and in the right place, based on logic included with the CDS intervention | Increase CDS utility, efficiency, and integration with clinic workflows |
5 | Guidelines should facilitate selective filtering or tailoring of rules | Specify explicitly when particular rules either apply or don’t apply in the rule’s logic description. | Allow rules to be turned off when they do not apply to a clinical context (e.g., specific practices, physicians, specialties, or clinical situations) |
6 | Guidelines should support the HL7 Infobutton standard | Specific definitions of items such as clinical problems, medications, and laboratory tests should be clearly defined using standardized data types | Allows EHRs to link to specific sections of a guideline and provide context-sensitive explanations |
7 | Composition of guideline development groups | CPG development groups/committees should include well-trained and experienced clinical informaticians | CPGs will be easier to transform into computer executable forms |