Context  Care delivery organizations face challenging imperatives to measurably improve clinical performance. Clinical decision support (CDS) is widely expected to play a critical role in addressing these challenges, but its deployment is often problematic and its full value has not been widely realized.

Objective  The project goal is to build a scalable collaborative model for synthesizing, implementing, and evaluating successful approaches for applying CDS to performance improvement imperatives which generally revolve around things that should always happen or never happen. A small core group of care delivery organizations and informatics experts is beginning the process by focusing on a single topic; venous thromboembolism (VTE) prophylaxis. Near term objectives (2009) include demonstrating that individual organizations can enhance the value and results of their VTE CDS efforts through structured, goal-oriented collaboration. Longer-term objectives include scaling successes with this initial effort to include more participants and other improvement imperatives.

Design, Setting, and Participants   Six care delivery organizations with active CDS efforts addressing VTE prophylaxis are documenting their efforts using a standardized template. Frequent project meetings and a wiki adapted to the project are being used to facilitate collaboration.  Developed by the project team, the template allows participating organizations to compare their infrastructure, CDS approaches, results and learning in a structured fashion.  By highlighting successful or promising approaches across deployments, this comparison will support the synthesis of ‘model practices’ for CDS deployment and value realization. Each organization will then conduct a ‘gap analysis’ focusing on differences between its current approach and the model practices, and then modify its approach as appropriate. 

Deliverables and Main Outcome Measures Deliverables for the first project phase (ending 4/09) include:

• the completed template outlining each pilot site’s CDS deployment and results (e.g. structure, process and outcome metrics about each organizations VTE/CDS efforts as available);
• the synthesized picture of model CDS practices for VTE;
• anecdotal feedback about each organization’s gap analysis and plans based upon it (structure, process, and outcomes);
• map of ideal CDS environment beginning with a completely paper based organization; and
• process to scale findings to more topics and additional healthcare organizations

  In subsequent project phases, the template and collaborative approach will be scaled (ideally to a national/international level) to include many other sites and additional priority targets. At each phase, outcomes measures will include the extent to which participating organizations report that the collaborative process is enhancing the efficiency and effectiveness of their CDS efforts, and the extent to which these CDS activities are contributing to measurable improvement in priority outcome targets (initially VTE prophylaxis and event rates), regardless of infrastructure (paper, digital or hybrid), including challenges and lessons learned. 

Results  The learning model enabled through the collaborative approach allowed each participating care delivery organization to learn from their peer participants and improve their overall application of CDS to VTE [provide anecdotes/examples in the paper/presentation…].  VTE prophylaxis rates, together with other process/outcome metrics showed promising improvements over the initial project phases [need to discuss if this is realistic]. Participants outline implications of their initial collaborative efforts for further developing, implementing, evaluating and disseminating model CDS practices for VTE and other targets at facilities of different size, infrastructure, patient acuity levels, and the like.

Conclusion The dynamic, collaborative learning exchange model for successful CDS application, can be scaled to accelerate CDS value on a national scale.  The project team has begun efforts to deliver on this promise.