Clinical Decision Support and Meaningful Use Stage II

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I have just completed the design/specification of clinical decision support feature for an EHR system. The EHR vendor I am working for these days is seeking to have their system certified for Meaningful Use stage II. Hence the objective was to design clinical decision support that fulfils EHR certification criteria as mentioned here: http://www.healthit.gov/sites/default/files/170_314a8cds_2014_tp_approvedv1.3.pdf

Another objective was to design it in a way that makes it possible to create clinical decision support interventions declaratively in order to support clinical quality measures (instead of coding the logic in the system through programming in order to show an alert for example).

Certification requirements says that the users should be able to select CDS interventions based on each one and at least one combination of the following data:
  • Problem list
  • Medication list
  • Medication allergy list
  • Demographics
  • Laboratory tests and value/results
  • Vital signs

The MU stage II core objective related to CDS says:
"Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions." 

While designing CDS I kept glancing at the definition of clinical quality measures, we are planning to support, in order to make sure CDS supports creation of interventions, relevant to selected CQMs, declaratively. Providing support to create CDS interventions for CQMs declaratively apparently is not a certification requirement and it can be hard-coded in the system as well, but I decided to have it in that way in order to make it more configurable/flexible and to eliminate the development efforts of hard coding these interventions for selected CQMs.

The clinical decision support I’ve designed allows creation of CDS rules based on any combination of above mentioned data and also makes it possible so that individual users/providers can switch the rules on and off based on their own preferences.

Hope once implemented it will not only pass the certification test but will also help clinicians improve clinical quality and patient safety.


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