Translating an evidence-based clinical pathway into shareable CDS: developing a systematic process using publicly available tools

Abstract

Objective: To develop a process for translating semi-structured clinical decision support (CDS) into shareable, computer-readable CDS.

Materials and methods: We developed a systematic and transparent process using publicly available tools (eGLIA, GEM Cutter, VSAC, and the CDS Authoring Tool) to translate an evidence-based clinical pathway (CP) into a Clinical Quality Language (CQL)-encoded CDS artifact.

Results: We produced a 4-phase process for translating a CP into a CQL-based CDS artifact. CP content was extracted using GEM into discrete clinical concepts, encoded using standard terminologies into value sets on VSAC, evaluated against workflows using a wireframe, and finally structured as a computer readable CDS artifact using CQL. This process included a quality control step and intermediate products to support transparency and reuse by other CDS developers.

Discussion: Translating a CP into a shareable, computer-readable CDS artifact was accomplished through a systematic process. Our process identified areas of ambiguity and gaps in the CP, which generated improvements in the CP. Collaboration with clinical subject experts and the CP development team was essential for translation. Publicly available tools were sufficient to support most translation steps, but expression of certain complex concepts required manual encoding.

Conclusion: Standardized development of CDS from a CP is feasible using a systematic 4-phase process. CPs represent a potential reservoir for developers of evidence-based CDS. Aspects of CP development simplified portions of the CDS translation process. Publicly available tools can facilitate CDS development; however, enhanced tool features are needed to model complex CDS statements.

Keywords: clinical decision support; clinical quality language; pathways, dissemination, Clostridoides difficile.

Figure 1.

CP (L2) to CQL (L3) translation process overview.

Figure 2.

Example conversion of CP branch point into recommedation statements. A single CP branch point is broken out into 4 recommendation statements. Each recommendation statement has 2 patient characteristics and 1–2 associated clinical activities.

Figure 3.

CDS-AT being used to encode content as CQL.

Figure 4.

Example value set for “Vomiting potentially due to CDI.” This value set includes codes from ICD-10 and is a subset of the codes representing the clinical focus of “symptoms of fulminant CDI.” The inclusion criteria indicate the search string used to generate this value set, allowing for complete transparency of the value set development.