National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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The Learning Health System Series

Optimizing Strategies for

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CLINICAL
DECISION
SUPPORT

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Summary of a Meeting Series

James E. Tcheng; Suzanne Bakken; David W. Bates; Hugh Bonner III; Tejal K. Gandhi; Meredith Josephs; Kensaku Kawamoto; Edwin A. Lomotan; Erin Mackay; Blackford Middleton; Jonathan M. Teich; Scott Weingarten; Marianne Hamilton Lopez, Editors

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WASHINGTON, DC
NAM.EDU

Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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NATIONAL ACADEMY OF MEDICINE • 500 FIFTH STREET, NW • WASHINGTON, DC 20001

NOTICE: This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a useful contribution worthy of public attention, but does not represent formal endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors’ organizations.

Support for this publication was provided by the Office of the National Coordinator for Health Information Technology.

Library of Congress Cataloging-in-Publication Data

Names: Tcheng, James E., editor. | National Academy of Medicine (U.S.), issuing body. | Optimizing Strategies for Clinical Decision Support (Meeting) (2016-2017 : Washington, D.C.)

Title: Optimizing strategies for clinical decision support : summary of a meeting series / James E. Tcheng [and 12 others], editors.

Description: Washington, DC : National Academy of Medicine, [2017] | Series: The learning health system series | Includes bibliographical references. | Identifiers: LCCN 2017055006 (print) | LCCN 2017056753 (ebook) | ISBN 9781947103092 (Ebook) | ISBN 9781947103085 (pbk.) |

Subjects: | MESH: Decision Support Systems, Clinical | Clinical Decision-Making | Medical Informatics | Congresses

Classification: LCC R858 (ebook) | LCC R858 (print) | NLM W 26.55.D2 | DDC 610.285--dc23

LC record available at https://lccn.loc.gov/2017055006

Copyright 2017 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: Tcheng, J. E., S. Bakken, D. W. Bates, H. Bonner III, T. K. Gandhi, M. Josephs, K. Kawamoto, E. A. Lomotan, E. Mackay, B. Middleton, J. M. Teich, S. Weingarten, and M. Hamilton Lopez, editors. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: National Academy of Medicine.

Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—GOETHE

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Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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ABOUT THE NATIONAL ACADEMY OF MEDICINE

The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, medical care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

Learn more about the National Academy of Medicine at NAM.edu.

Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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STEERING COMMITTEE

JAMES E. TCHENG, MD, FACC, FSCAI, FSEC, Duke University School of Medicine (Chair)

SUZANNE BAKKEN, PhD, RN, FAAN, FACMI, Columbia University

EDWIN A. LOMOTAN, MD, FAAP, Agency for Healthcare Research and Quality

DAVID W. BATES, MD, MSc, Brigham and Women’s Hospital

ERIN MACKAY, MPH, National Partnership for Women & Families

HUGH BONNER III, MD, Saint Francis Healthcare

TEJAL K. GANDHI, MD, MPH, CPPS, National Patient Safety Foundation

JONATHAN TEICH, MD, PhD, Brigham and Women’s Hospital, Harvard University

MEREDITH JOSEPHS, MD, MPH, FAAFP, Privia Health

SCOTT WEINGARTEN, MD, MPH, Cedars-Sinai Health System

NAM Staff

Development of this publication was facilitated by contributions of the following NAM staff, under the guidance of Michael McGinnis, MD, MPP, NAM Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System:

MARIANNE HAMILTON LOPEZ, PhD, MPA, Senior Program Officer and Project Director

MICHELLE JOHNSTON-FLEECE, MPH, Senior Program Officer

VANANH VO, Senior Program Assistant, after November 2016

ROSHEEN BIRDIE, Senior Program Assistant, until September 2016

LAURA DeSTEFANO, Director of Communications

KYRA E. CAPPELUCCI, Communications Specialist

MOLLY DOYLE, Communications Specialist

Consultant

JOE ALPER, rapporteur

Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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REVIEWERS

This special publication was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine. We wish to thank the following individuals for their review of this publication:

ANDREW BAZEMORE, MD, MPH, Robert Graham Center, American Academy of Family Physicians

JONATHAN B. PERLIN, MD, PhD, MSHA, MACP, FACMI, HCA (Hospital Corporation of America)

ADAM WRIGHT, PhD, FACMI, Harvard Medical School and Brigham and Women’s Hospital

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the publication, nor did they see the final draft before it was published. Review of this publication was overseen by Marianne Hamilton Lopez, PhD, MPA, Senior Program Officer, NAM; and Michael McGinnis, MD, MPP, Leonard D. Schaeffer Executive Officer, NAM. Responsibility for the final content of this publication rests entirely with the editors and the NAM.

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Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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ACKNOWLEDGMENTS

We would like to thank Daniel Bearss with the National Academies of Sciences, Engineering, and Medicine for contributing to the development of this publication through fact-checking assistance.

Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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ACRONYMS AND ABBREVIATIONS

AFA Analytic Framework for Action
AHRQ Agency for Healthcare Research and Quality
AMIA American Medical Informatics Association
API application program interface
APMs alternative payment models
CDS clinical decision support
CDSC Clinical Decision Support Consortium
CHIME College of Healthcare Information Management Executives
CMS Centers for Medicare and Medicaid Services
CPG clinical practice guidelines
EHR electronic health record
FDA U.S. Food and Drug Administration
FHIR Fast Healthcare Interoperability Resources
HFMA Healthcare Financial Management Association
HHS Department of Health and Human Services
HIMSS Healthcare Information and Management Systems Society
HITECH Health Information Technology for Economic and Clinical Health Act
HL7 Health Level Seven international standards
ICER Institute for Clinical and Economic Review
IHI Institute for Healthcare Improvement
IOM Institute of Medicine
ISMP Institute for Safe Medication Practices
IT information technology
Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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MACRA Medicare Access and CHIP Reauthorization Act
MRI magnetic resonance imaging
NAM National Academy of Medicine
NASEM The National Academies of Sciences, Engineering, and Medicine
NCQA The National Committee for Quality Assurance
NQF National Quality Forum
ONC Office of the National Coordinator for Health Information Technology
PCOR patient-centered outcomes research
PCORI Patient-Centered Outcomes Research Institute
PSOs patient safety organizations
Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: The National Academies Press. doi: 10.17226/27122.
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 Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series
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As a result of a collaboration between the National Academy of Medicine (NAM) and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds on a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision making and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of CDS.

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