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Phase 3 will replicate successful knowledge ecosystem enhancement approaches from the Phase 2 pilots (and related ecosystem enhancement efforts) to many clinical targets and apply them broadly in care delivery settings and other organizations contributing to the ecosystem cycle. Leveraging the maturing reference architecture and supported by the maturing Roadmap Execution Steering Committee, PPP, and Coordinating Center established in prior phases, this phase will enhance the AHRQ DKP, other DKPs, and public/private marketplaces to begin enabling widespread organizational LHSs and a U.S. national LHS that starts to deliver significant progress toward the Quintuple Aim for many clinical targets. Phase 3 will demonstrate a high-functioning knowledge supply chain where the Phase 2 tools for making evidence and guidance computable support the rapid incorporation of impactful new study results into living systematic reviews, which in turn trigger rapid updating of living guidance, which in turns triggers rapid updating of CDS interventions and eCQMs. Phase 3 will also more broadly promote continuous learning to support performance improvement for providers and the broader healthcare workforce. Building upon the Phase 2 pilots, this phase will widely incorporate healthcare leadership and system culture as drivers to achieve the ecosystem cycle goals.

Phase 3 Deliverables

  • PPP-driven collaboration network and infrastructure for broadly fostering LHSs and realization of the Quintuple Aim supported by a high functioning knowledge ecosystem, including further enhancements to the Coordinating Center
  • Production version of an enterprise wide AHRQ DKP including computability for all resources from AHRQ and others, as appropriate
  • Production version of tooling that makes information processing in the knowledge ecosystem cycle more computable and user friendly and information transfer between these steps more seamlessly interoperable for all clinical targets, including a full Production version of an open, public-sector marketplace that delivers offerings from all Federal agencies (and other interested public sources) as appropriate
  • Living evidence, guidance, and CDS interventions/eCQMs for up to 25 clinical targets prioritized by the Roadmap Execution Steering Committee/PPP (including the eight clinical targets from Phases 1 and 2), produced and maintained using the tooling deliverables
  • Enhanced playbook for creating and maintaining living computable evidence, guidance, and CDS/eCQMs that is coordinated with investments from other stakeholder organizations to generate supporting educational materials (e.g., courses, learning communities)
  • Results from developing and clinically implementing the living CDS interventions and eCQMs (and AHRQ DKP) for the eight Phase 1 and 2 clinical targets in at least 50 different CDOs (with wide variation in size, populations and regions served, health IT sophistication and systems) affecting care for at least 20 million patients, which includes assessing and documenting:
    • The implications of these results for more broadly leveraging the AHRQ DKP and other knowledge ecosystem components during Phase 3 Scaling
    • How system leaders were engaged to foster a learning culture that explicitly supports interprofessional continuing education for team collaboration, adoption, and widespread implementation of CDS interventions in variable practice settings
  • Enhanced Playbook for successfully implementing CDS interventions and eCQMs that covers in detail at least the eight Phase 1 and 2 clinical targets (applicable to other targets as well) that is coordinated with investments from other stakeholder organizations to generate supporting educational materials (e.g., courses, learning communities)
  • Requirements and project plans for broadly scaling AHRQ DKP and other Knowledge Ecosystem components, to support the ecosystem cycle for many more clinical targets and setting than addressed in Phase 2

Phase 3 Tasks, Timeline 

Table 13. ACTS Phase 3 Create/Use Governance & Collaboration Tasks, Timeline 

Task

Start

End

3          Phase 3. Scaling

10/2027

9/2030

3.1      Enhance PPP/Roadmap Execution Steering Committee for Phase 3 Scaling

Month 1

Month 4

3.2      Modify collaboration infrastructure to support PPP/Roadmap Execution Steering Committee and stakeholder engagement

Month 1

Month 4

3.3      Support Phase 3 PPP/Roadmap Execution Steering Committee

Month 5

Month 36

3.3.1        Maintain PPP



3.3.2        Develop data sharing agreements for AHRQ DKP/marketplace

Month 5

Month 9

3.3.3        Identify up to 25 additional clinical targets beyond Phase 2 targets

Month 5

Month 7

3.3.4        Establish criteria to select tools/resources to scale

Month 5

Month 7

3.3.5        Establish criteria to select clinical sites for scaled guidance implementation

Month 5

Month 7

3.3.6        Ensure broad stakeholder engagement in scaling requirements development

Month 5

Month 11

3.3.7        Ensure broad stakeholder engagement in Agile Scaling work on Phase 3 Infrastructure, Evidence/Guidance, and Implementation Tasks

Month 10

Month 30

3.3.8        Ensure broad stakeholder engagement in Phase 3 Scaling feedback evaluation and Phase 4 project plan development

Month 29

Month 36

3.4      Enhance and leverage the Coordinating Center

Month 1

Month 36

3.4.1        Institute project management for AHRQ DKP Scaling Phase

Month 1

Month 36

3.4.2        Coordinate scaling requirements gathering, development, evaluation, and Phase 4 LHS/Quintuple Aim planning with other pertinent initiatives

Month 3

Month 36

3.4.3        Cultivate opportunities for public and private organizations to contribute to and benefit from Phase 3

Month 1

Month 36

3.4.4        Hold an annual meeting

Month 1

Month 36


Table 14. ACTS Phase 3 Enhance/Leverage Infrastructure Tasks, Timeline 

Task

Start

End

3.5      Maintain Phase 2 AHRQ DKP Pilot and Enhance into Full Enterprise Solution

Month 1

Month 36

3.5.1        Leverage requirements from Phase 2 pilot to enhance AHRQ DKP technology and processes

Month 1

Month 18

3.5.2        Leverage requirements from Phase 2 pilot to enhance AHRQ DKP content

Month 6

Month 18

3.5.3        Stage and test platform, gather feedback, and modify development environment

Month 19

Month 24

3.5.4        Produce an enterprise Production AHRQ DKP pilot

Month 25

Month 36

3.5.5        Maintain the AHRQ DKP

Month 1

Month 36

3.6      Integrate and enhance Phase 2 tooling

Month 5

Month 28

3.6.1        Determine requirements for a high-functioning knowledge supply chain for the 8–25 clinical targets

Month 5

Month 11

3.6.2        Produce tooling for a high-functioning knowledge supply chain

Month 12

Month 28


Table 15. ACTS Phase 3 Enhance/Develop Living, Computable Guidance Tasks, Timeline 

Task

Start

End

3.7      Demonstrate a high-functioning knowledge supply chain for at least 25 clinical targets

Month 3

Month 36

3.8      Use and enhance the Living Guidance Development Playbook

Month 3

Month 36


Table 16. ACTS Phase 3 Enhance Guidance Implementation & Assessment Tasks, Timeline

Task

Start

End

3.9      Integrate the living CDS/eCQM into information systems and clinical workflows in at least 50 CDOs for 8–25 clinical targets

Month 8

Month 28

3.9.1        Select CDO sites, providers, and patients for guidance implementation and assessment

Month 8

Month 14

3.9.2        Integrate interventions into systems, reengineer workflows, and train staff

Month 15

Month 21

3.9.3        Deploy tools and workflows into care delivery activities

Month 22

Month 28

3.9.4        Demonstrate computable information flow within the knowledge ecosystem cycle

Month 22

Month 28

3.10    Use and enhance the Implementation Playbook

Month 3

Month 34


Table 17. ACTS Phase 3 Evaluate/Plan Roadmap Execution Tasks, Timeline 

Task

Start

End

3.11    Gather and analyze scaling feedback and develop requirements and project plans for Phase 4

Month 18

Month 36

3.11.1     Develop a Phase 3 evaluation plan

Month 18

Month 28

3.11.2     Implement the Phase 3 evaluation plan

Month 29

Month 36

3.11.2.1     Determine requirements and a project plan to convert the Scaled AHRQ DKP into a fully functional AHRQ DKP during Phase 4

Month 29

Month 36

3.11.2.2     Provide requirements and a Phase 4 project plan to demonstrate knowledge-ecosystem-enabled LHS function in at least 10 CDOs

Month 29

Month 36

3.11.3     Produce a Phase 3 report

Month 29

Month 36

3.12    Develop and execute research plan

Month 3

Month 36

3.12.1     Define strategies to incorporate AHRQ's DHRSP into Phase 3 and apply Roadmap results into the DHRSP

Month 3

Month 9

3.12.2     Ensure bidirectional support between DHRSP strategic pillars and ACTS Phase 3 AHRQ DKP and knowledge ecosystem enhancement scaling projects and resource enhancement/development tasks

Month 10

Month 36

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