Korábbi változatok

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Illustrate how for a sample target (anticoagulation and/or COVID-19 testing/triage): we can signal to care teams (through 'living' CDS interventions) when a change in the evidence-review-guidance supply chain content for this target indicates a change in recommended care. Or this change indicates that the strength of evidence/guidance supporting a recommendation has changed. (The latter is important so this new information can be factored into patient-clinician shared decision making accordingly.)

Approach:

• VA and UMN (for the most part) manage all facets of this supply chain and also consume its results via CDS interventions that support care for your respective their patient populations. This suggests that these 2 organizations could each be logical homes/centerpieces for efforts focused on demonstrating the tighter link outlined above between new guidance/evidence and updating the corresponding CDS interventions (Explore having them serve as a core for addressing the goal.
  • Cultivate synergies between these 'full cycle' efforts and related Collaborative participant efforts - e.g.,
  focused on anticoagulation and
  • NACHC (testing/triage
  [here is the ACEP
  • in health centers), ACEP/EvidenceCare COVID-19 Severity Classification/Triage/Disposition tool
  ]).This would mean having the teams that are
  • (see here), Australia Living COVID-19 Guidelines (anticoagulation), U Melbourne COVID-CARE and related efforts, etc.
• Have teams responsible in each of these organizations for evidence surveillance/synthesis, guidance development/updating, and CDS development/updating/deployment collaborate among themselves and with other organizations in the Collaborative on this 'update notification' process and tooling.
• We could explore ways to leverage related efforts for content and approaches to apply in the notification system. For example, consider Consider mutually beneficial ways to apply SRDR/COKA, C19HCC Digital Guideline WG, COVID-NMA, COVID-END, AU Living Guidelines, and related efforts to produce a a triggering system to that  suggests suggests to living CDS owners/implementers that updates should be considered.
  For example, below is a sampling of external evidence/guidance sources
  • see sampling below that could
  potentially
  • be leveraged
  to enhance current VA/UMN processes in developing the 'update notification' system. We could start
  • Start by documenting how evidence/guidance changes are detected and addressed in current VA/UMN processes, and exploring enhancing these approaches to include a scalable notification function that propagates supply chain updates to all pertinent stakeholders throughout the chain, including those responsible for developing/maintaining CDS interventions.  
  • We could begin by synthesizing Phased approach
    • Synthesize a largely manual update detection and notification mechanism that runs throughout the supply chain, then semi-automated approaches (e.g., that detect changes on target web pages), and ultimately fully automated approaches that leverage computable, standards-based, interoperable information throughout the supply chain.
  • Important foundational work for this has been laid in SRDR/COKA collaborations, and we should explore how to fully leverage and build on this in developing an 'update notification' approach. Especially since SRDR is an important component of AHRQ's current digital knowledge platform.

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