Table 1 Supporting Individualized Health Care: Recommendations for Stakeholders

Government

* Support development of a minimum data set of personal attributes that contribute to individualized care

* Set national priorities for health care quality improvement driven by the National Quality Forum

* Identify priorities for Federally-funded CDS efforts

* Evaluate the impact of these programs on high-priority areas by representatives of Federal agencies

* Work with HITSP [31] to identify standard data types needed to support CDS tools of high-priority conditions determined by national priority-setting efforts

* Coordinate with CCHIT [32] on certification criteria for CDS to enable support of personalized medical practices

* Expand research support to promote best practices for utilizing CDS tools in EHR systems

Researchers and Research Institutions

* Engage professional societies and EHR vendors to understand the types of information necessary to integrate new CDS tools into health care

* Explore methodologies to present tools to providers

* Assess patient-provider interfaces

* Evaluate the role and impact of electronic tools in shared decision-making

* Support innovative software applications that integrate multiple variables (e.g., test results, medical/medication history, patient preferences, family health history).

Developers of Electronic Information Tools

* Create tools to identify appropriate molecular diagnostic tests, provide additional background material or references, or produce a personalized interpretation based on existing medical data at the point-of-care

* Build tools to support workflow integration for diagnostic test orders, integration of test results into confirmatory tests, intervention options, and patient information resources.

Developers of Clinical Practice Guidelines (CPG) and Quality Measures (QM)

* Include patient-specific factors for disease management when supported by an evidence base (CPG)

* Incorporate differences among subsets of patients (CPG)

* Translate practice guidelines into machine-readable formats to integrate into CDS tools (CPG)

* Work with electronic tool developers to create standard data formats that can be used to structure guidelines for import and use in CDS formats (CPG)

* Work with professional societies to design measures that incorporate into EHRs (QM)

* Harmonize measure specifications with EHR standards and requirements (QM)

* Ensure that EHRs are equipped to capture dataset to evaluate quality measures (QM).

Developers of EHR Standards

* Encourage standards development for integrating practice guidelines into CDS tools and with EHR systems

* Prioritize genetic test and family history application standards development and certification processes

* Foster development of evaluation criteria for the usability and effectiveness of CDS tools in EHR systems.