title: Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts.
abstract: OBJECTIVE
  To identify key principles for establishing a national clinical decision support (CDS) knowledge sharing framework.
  
  
  METHODS
  As part of an initiative by the US Office of the National Coordinator for Health IT (ONC) to establish a framework for national CDS knowledge sharing, key stakeholders were identified. Stakeholders' viewpoints were obtained through surveys and in-depth interviews, and findings and relevant insights were summarized. Based on these insights, key principles were formulated for establishing a national CDS knowledge sharing framework.
  
  
  RESULTS
  Nineteen key stakeholders were recruited, including six executives from electronic health record system vendors, seven executives from knowledge content producers, three executives from healthcare provider organizations, and three additional experts in clinical informatics. Based on these stakeholders' insights, five key principles were identified for effectively sharing CDS knowledge nationally. These principles are (1) prioritize and support the creation and maintenance of a national CDS knowledge sharing framework; (2) facilitate the development of high-value content and tooling, preferably in an open-source manner; (3) accelerate the development or licensing of required, pragmatic standards; (4) acknowledge and address medicolegal liability concerns; and (5) establish a self-sustaining business model.
  
  
  CONCLUSIONS
  Based on the principles identified, a roadmap for national CDS knowledge sharing was developed through the ONC's Advancing CDS initiative.
  
  
  CONCLUSIONS
  The study findings may serve as a useful guide for ongoing activities by the ONC and others to establish a national framework for sharing CDS knowledge and improving clinical care.
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84092, USA. kensaku.kawamoto@utah.edu
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
authors.forename: Tonya
authors.initials: T
authors.lastname: Hongsermeier
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Janet
authors.initials: J
authors.lastname: Lewis
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Bell
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D004059:Diffusion of Innovation; D006801:Humans; D033181:Information Dissemination; D017146:Models, Organizational; D014481:United States