Korábbi változatok

• Implement Guidance includes integrating the computable guidance into organizational information system infrastructure, and deploying the intervention to users, and maintaining the interventions over time. Includes looking at 'leading' indicators (e.g., process changes) regarding intervention use and results. (as opposed to the next "Analyze Care Results" table below that addresses 'lagging indicators' (e.g., clinical outcomes))

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Regarding Value Sets recommend the following process (applies to anticoagulation, testing/triage, vaccines, steroids, and any other topic):

1. Take inventory of what value sets you’ll need (be specific)
2. Check Alliance website or Value Set Authority Center (VSAC), we might have already published some of them among the 600+ value sets
3. If certain value sets are not present or you are unsure, contact Victor Lee (Victor_Lee@ClinicalArchitecture.com) to inquire or to request development

Clinical Architecture and other Alliance collaborators are donating our efforts, and Clinical Architecture is leveraging its software tooling, hosting infrastructure, and manual labor to donate all of the COVID-19-related value set content to the public domain (i.e., completely free, no strings attached). That being said, we all have day jobs, so we appreciate having as much lead time as possible to fulfill requests. Happy to take questions.

• See output repositories for Make Guidance Computable

Definition: Implementation is the process of integrating the computable guidance into the practice system, deploying the intervention to users, and maintaining the intervention over time. The process includes pre adoption of innovation (e.g. integration of innovation into EHR, creation of policies and procedures, training, etc.), actual adoption (daily use) and post adoption (maintenance/sustainability). (See Rabin et al. 2008)

Goal: “To assess the extent to which implementation is effective in a specific context to optimize intervention benefits, prolong sustainability of the intervention in that context, and promotes dissemination of findings into other contexts” (Damschroder, et al. 2009)

Framework: The Consolidated Framework for Implementation Research (CFIR), a comprehensive implmentation model that consolidates a broad range of constructs from many theories (theories related to “dissemination, innovation, organizational change, implementation, knowledge translation, and research uptake”)

Rabin BA, et al. A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2008 Mar-Apr;14(2):117-23.

Damschroder LJ, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50.

• See output repositories for Make Guidance Computable

Sources for Computable guidance  

• Here, please add sources from where organizations can find computable guidance

Implementation should follow selecting the appropriate computable guidance. If the  guidance is not available in a computable format, standards should be followed to translate the knowledge into computable format first. 

Process of translating the guideline text into a computable format

• FHIR
• Shiffman RN, et al. Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. J Am Med Inform Assoc. 2004;11(5):418-426. doi:10.1197/jamia.M1444
• Tso GJ, et al. Automating Guidelines for Clinical Decision Support: Knowledge Engineering and Implementation. AMIA Annu Symp Proc. 2017;2016:1189-1198.

Criteria for selecting appropriate computable and un-computable guidance

Clinical Practice Guidelines We Can Trust (2011)

Successful integration of CDSs into the workflow

• Tu SW, et al. Modeling guidelines for integration into clinical workflow. Stud Health Technol Inform. 2004;107(Pt 1):174-8.
• I think Matt has published something about integrating CDSs into the workflow, but I could not locate the source

Standards for implementation success

• C19 Digital Guidelines WG developing and implementation guide for COVID-19 interventions

• A practical guide to using the ImpRes tool
• Implmentation outcome instruments for use in healthcare settings
• Measuring factors affecting implementation of health innovations
• We need to add more about the “integration (pre adoption) piece” here

• HITEQ Center Guide to Improving Care Processes and Outcomes
• HIMSS Improving Outcomes with CDS