Implementing a Clinical Decision Support System

Grading

This assignment is worth 30 points or 30% of your overall class grade.

Due Date

Thursday, May 12, 11:59:59 PM

Late assignments will not be accepted.

Reading

Greenes, Chapter 25. A CDS Implementation Guide: Practical Considerations

Greenes, Chapter 3. Features of Clinical Decision Support

Greenes, Chapter 22. Cognitive Considerations for HIT

Greenes, Chapter 23. Organizational and Cultural Change

Greenes, Chapter 24. Managing the Investment in CDS

** OPTIONAL ** Greenes, Chapter 30. Looking Ahead: The Road to Broad Adoption

** OPTIONAL ** Greenes, Chapter 10. Human-Intensive Techniques

** OPTIONAL ** Greenes, Chapter 11. Generation of Knowledge for CDS

Assignment

For this assignment, you will be working as a team.

You will be starting an implementation project for a clinical decision support system. As the project managers, you are responsible for identifying the key issues within your hospital (e.g. legal/regulatory, organizational/cultural, software/IT, and clinical workflows) and creating a plan for addressing these issues. I will be reading this assignment from the perspective of your head of informatics. While you won't be able to cover everything in great detail, the goal is to cover enough that the project can be successfully kicked off (with respect to your particular topic).

Given your current positions and extensive experience and background, I am assuming that you have experience planning and executing implementation projects. You will also be focusing on a project as part of your program. As such, this is an opportunity for a focused dive into a particular area of interest to you.

For example, you may choose to focus on addressing the organizational or cultural issues within your organization. You may focus on the knowledge management portion, or data capture and semantic interoperability. As we discussed in class, there are quite a few different areas to focus on and I would choose one that you are either uncomfortable with or would like to learn more about.Whatever you choose, please make it explicit and clear because there is a natural overlap between all aspects of the project. By letting me know the specific area you're focusing on, I will be able to keep that context in mind as I read through your assignment.

Some areas to consider are:

• Organizational issues
• Cultural issues
• Change management
• Knowledge management
• Data extraction and interoperability

As soon as you feel like you have a topic of interest and have discussed it with your team in the context of your CDS tool, please create an outline and then check in and discuss with me via email or Zoom to make sure we're all on the same page and that your topic is not too large nor too small

As with any implementation project, this is your one opportunity to put the framework and structure in place to guide the implementation. Anything left out or forgotten during this phase may have drastic consequences later. For example, it may be easiest to say that you will not perform any upgrades to the software once the algorithms have been tested and deployed. This is often the case with algorithms embedded inside bedside monitors such as EKG's. Obviously, this prevents you from ever deploying future versions, whether as an incremental improvement or as a critical bugfix. On the other hand, if you incorporate an upgrade cycle, you must then add a plan for testing of the new system alongside the currently deployed one.

As I mentioned during the intensive, the only wrong decision is an uninformed and unjustified one.

Given that each group will likely choose a different area of focus, it is difficult to list out the specific questions I'd like you to address because it is highly dependent on the use case. However, to give you a sense of the level of depth I'd like you to achieve, imagine if your chosen area is legal/regulatory. Some questions you would want to address (and justify) are:

1. Is this predominantly a software or hardware product?
2. What liabilities may exist if this is a software product?
3. What if you just add a blanket warning, "This software is intended to help you view the data more conveniently. Any decisions you make must be yours alone, based on your training, expertise, and licensure as a clinician." - is this enough?
4. Should you have a different warning or disclaimer?
5. Does this need to be pushed through the FDA before you use it with real patients?
6. What are the implications if you want to upgrade the software?
7. What is the process for training users?
8. Will users be able to use this from personal devices? Mobile phones, tablets, laptops?

That said, you should address the following points at a minimum.

1. Describe the clinical or business need underlying your CDS tool
2. Describe your CDS tool and how it will help improve the decision-making process
3. Review the 5 components of CDS (page 39 of the slides) and discuss each in the context of your project
4. Focus on your implementation topic of interest and work through it. Your goal should be to effectively and adequately address that particular issue. In other words, as the head informatcist on your implementation team, I should feel comfortable starting on the project and believe that we have an successful plan in place

The assigned reading and optional readings should give you a general starting point. There are additional chapters of Greenes that I can make available if requested. Additionally, please conduct your own research using journal papers, articles, blog posts and any other resources you would reasonably consider as part of an actual implementation. At the doctoral level, the goal is to get you to start thinking about and attacking problems for which there may not be a clearcut answer or approach. So, please do as much (or as little) research as you need and be creative!

Deliverables

For this assignment, the primary deliverable is a project plan/report. Please include figures, diagrams, etc. as you see fit. There is no length requirement. The goal is to effectively communicate your plan and justify your approach as appropriate.