Overall Objectives and Rationale
Clinical decision support (CDS) “provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.” CDS is one of the most critical components of health information systems because they can improve patient outcomes and lead to higher-quality health care. With the adoption of electronic health record (EHR) systems reaching over 90% of health care settings in the U.S., unprecedented opportunities exist to improve the quality and value of health care through CDS interventions at the national scale. However, to improve patient outcomes, increase clinician efficiency, and reduce clinician burnout, CDS tools need to be designed and implemented according to best practices and disseminated across healthcare settings through standards-based approaches.
Taught by national leaders with decades of practical experience in the design, development, implementation, and evaluation of CDS, this online and hands-on course teaches state-of-the-art principles and best practices to enable effective CDS. Topics include a review of the various types of CDS tools; principles of CDS governance and knowledge management; CDS technical architectures, standards (FHIR, SMART, CDS Hooks, Infobutton), tools (OpenInfobutton, OpenCDS); and CDS implementation and evaluation. The course has been offered for over 20 years as a part of the graduate program at the University of Utah Department of Biomedical Informatics, which has a five-decade long history of innovations in CDS.
The course is targeted at any individual who is interested in CDS, regardless of background or prior experience. The student cohort is multidisciplinary, with backgrounds in health care delivery, public health, computer science, biology, genetics, and information technology. Examples of roles that could benefit from this course include those engaged with CDS governance and implementation at health care or public health organizations, CDS designers/developers, health IT designers/developers, CDS researchers, and clinical/health services researchers interested in applying CDS in their research.
At the completion of the course, students will be able to:
- Describe different kinds of CDS tools and their relevance to clinical problems.
- Apply current CDS architectures, standards and tools such as SMART on FHIR, CDS Hooks, HL7 Infobutton Standard, OpenInfobutton, and OpenCDS.
- Develop a CDS tool following best CDS design practices.
- Describe the challenges with effective CDS implementation and adoption, including potential pitfalls such as alert fatigue.
- Plan the implementation and evaluation strategy for a CDS intervention.
Canvas, the University of Utah’s online teaching resource, is used to manage the course. Students will be given instructions to use Canvas after they enroll. All course materials, activities, and communication are delivered through Canvas
Course Structure Overview:
This is a 16-week long, three credit-hour course organized in 14 modules. Each module covers a specific topic and includes recorded presentations, reading materials, a short weekly quiz, and a synchronous lab session. In addition, the course has three assignments and a semester-long group project. Weekly lab sessions are offered on Tuesdays at 7pm ET. Students can join either onsite at the Department of Biomedical Informatics or remotely via Web meeting. Lab sessions are recorded and posted to Canvas for those who cannot attend.
In-person meeting: An intensive, optional, half-day in-person session held in conjunction with the AMIA 2019 Annual Symposium will be offered every year. Students attending the Symposium will get together with instructors for networking, discuss topics related to the course and answer questions.
Course Outline – Fall 2019
|Module #||Module Title||Activities & Assignments|
|Module 1||Course overview, introduction to clinical decision support||Group project setup|
|Module 2||Task and Workflow implications for CDS||Infobuttons assignment|
|Module 3||Effectiveness of CDS|
|Module 4||CDS Governance|
|Module 5||Knowledge management and alert fatigue||SMART on FHIR assignment
Group project – CDS proposal
|Module 6||CDS architecture|
|Module 7||CDS languages and standards|
|Module 8||SMART on FHIR and CDS Hooks|
|Module 9||Shared decision making and CDS considering patient preferences||CDS Hooks assignment
Group project – CDS system specification
|Module 10||Public Health and CDS|
|Module 11||CDS to improve diagnosis making|
|Module 12||Challenges to adoption|
|Module 13||CDS on a national level||Group project – Implementation and evaluation|
|Module 14||Future of CDS|
|Group project – CDS system delivery and presentation|
To satisfactorily complete the course, participants need to:
1) Score at least 80% on the weekly quizzes (14 quizzes; 1 per module) – 15% of the final grade
We will test content with a short quiz every week. The aim of these quizzes is for students to demonstrate that they have engaged and learned the material. The quiz will be a mix of question types and will focus on the most important material covered each week. The quizzes will be open-book. Students will have a single 1-hour session to complete the quiz. The quiz must be completed within the hour once started.
2) Participate in online discussions (eight biweekly sessions) - 15% of the final grade
To facilitate participation and critical thinking among students, there will be a bi-weekly discussion question posted on the 'Discussions' section of the online learning platform. These questions will generally be opinion questions in which there is no right or wrong answer. The discussion board is mainly designed to stimulate students to think and research a particular topic and engage with other learners in the course. The initial response must be at least 250 words. Each student will be required to respond to at least one additional learner in the discussion area the week following the original posts. Responses should be at least 50 words in length and be more than a simple "I agree" or "Good post”.
3) Complete assignments (three individual assignments) - 25% of the final grade
Assignments are given throughout the semester to help the students obtain addition understanding on a topic. Students work on three individual project assignments throughout the course: an OpenInfobutton assignment, a SMART on FHIR, and CDS Hooks activity. In each assignment students will apply concepts taught in the course. These assignments will introduce students to CDS standards like SMART on FHIR app. Students will interact with JSON FHIR data files, a public FHIR server, a secure server hosting a SMART on FHIR application. During the OpenInfobutton assignment students will work with a mock EHR website coupled with HL7-compliant RESTful requests along with a display for the OpenInfobutton response.
4) Complete the group project (includes 4 deliverables) – 25% of the final grade
Throughout the course, students work in multidisciplinary teams to propose, design, and implement a functioning prototype of a standards-based CDS. Each team is assigned to a faculty mentor. The project is broken down into five deliverables that are graded independently: (i) CDS proposal and clinical rationale; (ii) CDS specification, including data requirements, knowledge representation, and user interface “mockups”; (iii) proposed implementation plan and evaluation; and (iv) presentation including a live demo of the CDS prototype.
5) Complete the Final Exam - 20% of the final grade
The final exam will be open book, but assistance or communication (verbal, electronic, or otherwise) with anyone else (fellow class members or not) is not allowed. The exam will be administered via Canvas at the end of the course. Students will have a set time to complete the exam once started. There will be only one chance to start and finish the exam. The exam will be a mix of questions: multiple choice, fill in the blank, short answer, etc. The questions address the material covered in lectures, readings, discussion boards, quizzes, and assignments.