title: Clinical Decision Support-based Quality Measurement (CDS-QM) Framework: Prototype Implementation, Evaluation, and Future Directions.
abstract: Electronic quality measurement (QM) and clinical decision support (CDS) are closely related but are typically implemented independently, resulting in significant duplication of effort. While it seems intuitive that technical approaches could be re-used across these two related use cases, such reuse is seldom reported in the literature, especially for standards-based approaches. Therefore, we evaluated the feasibility of using a standards-based CDS framework aligned with anticipated EHR certification criteria to implement electronic QM. The CDS-QM framework was used to automate a complex national quality measure (SCIP-VTE-2) at an academic healthcare system which had previously relied on time-consuming manual chart abstractions. Compared with 305 manually-reviewed reference cases, the recall of automated measurement was 100%. The precision was 96.3% (CI:92.6%-98.5%) for ascertaining the denominator and 96.2% (CI:92.3%-98.4%) for the numerator. We therefore validated that a standards-based CDS-QM framework can successfully enable automated QM, and we identified benefits and challenges with this approach.
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: Polina V
authors.initials: PV
authors.lastname: Kukhareva
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: David E
authors.initials: DE
authors.lastname: Shields
authors.affiliation: Quality Improvement and Safety Department, University of Utah Healthcare, Salt Lake City, UT.
authors.forename: Darryl T
authors.initials: DT
authors.lastname: Barfuss
authors.affiliation: Quality Improvement and Safety Department, University of Utah Healthcare, Salt Lake City, UT.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Halley
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Tippetts
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Warner
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Bray
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Staes
mesh_terms: D000046:Academic Medical Centers; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D005240:Feasibility Studies; D006801:Humans; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000592:standards*; D014589:Utah