What is Health Equity?
According to the Centers for Disease Control and Prevention (CDC)
Clinical Decision Support & (2023) health equity is:
• “The state in which everyone has a fair and just opportunity to attain
Health Equity their highest level of health. Achieving this requires focused and
ongoing societal efforts to address historical and contemporary
injustices; overcome economic, social, and other obstacles to health
and healthcare; and eliminate preventable health disparities.”
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What are Health Disparities? SDOH
• “Preventable differences in the burden of disease, injury, violence, or • Social determinants of health
opportunities to achieve optimal health that are experienced by (SDOH) are the conditions in the
socially disadvantaged populations.” (CDC, 2023) environments where people are
born, live, learn, work, play,
worship, and age that affect a
wide range of health,
functioning, and quality-of-life
outcomes and risks.
• Can be grouped into 5 domains
[Link] [Link]
How Can CDS Decrease Health Disparities?
• Improve implementation and adherence to clinical guidelines and
practices
• Increase screening for preventable diseases and chronic disease
complications
• Promote patient safety
• Reduce adverse outcomes
• Minimize clinician bias
• Raise clinician awareness of clinical gaps
• Rapid information retrieval à Clinician efficiency à More time for
shared decision making
Greenes, R. A., & Del Fiol, G. (2023). Clinical decision support and beyond: Progress and opportunities in knowledge-enhanced health and Healthcare (3rd ed.). Academic Press.
CDS - Health Equity Case Study
Health Equity Consideration for CDS 1) Watch the video:
2022 Tech Forum:
Developing Clinical Decision
TABLE 25.1 Health equity consideration for clinical decision support Support with SDOH Data for
• Aim to address recognized health disparities from the start Improved Patient Outcomes
• Use available technology to maximize reach to underserved populations (e.g., text messaging) 2) View the case study
• Include stakeholders from relevant communities in CDS development and implementation presented by the Centers
• Leverage multiple types of data to promote the most current and relevant evidence-based for Disease Control &
guidelines Prevention (CDC) starting at
• Ensure the guideline is derived from studies that included marginalized populations
minute 25, ending at approx.
• Link to services that can support recommended intervention (e.g., refer to local food pantry)
minute 53
• Make recommendations actionable and beneficial to all patients
• Test CDS in a variety of settings including with a diverse cohort of patients 3) Go to Blackboard, Week
• Design CDS tools that support sustainable use in underserved settings 10 ”Assignments &
• Align with existing quality and safety initiatives Activities” folder and
complete the participation
Greenes, R. A., & Del Fiol, G. (2023). Clinical decision support and beyond: Progress and opportunities in knowledge-enhanced health and Healthcare (3rd ed.). Academic Press.
quiz about the case study
Example of Public Health CDSS
• electronic Case Reporting (eCR) is an is designed to improve the
Clinical Decision Support for quality of reporting from healthcare providers to the public health
system.
Public Health • Currently, its primary function is to improve the completeness,
timeliness, and accuracy of clinical reports to public health of patients
with public health notifiable conditions.
• This system, while rapidly evolving, is also becoming a model for how
clinical decision support for critical issues might be implemented at a
national level.
Greenes, R. A., & Del Fiol, G. (2023). Clinical decision support and beyond: Progress and opportunities in knowledge-enhanced health and Healthcare (3rd ed.). Academic Press.
CDSS – eCR Workflow
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Future Direction of CDS
• Government certifications and standards
Future Directions of Clinical Decision • Technical Standards for interoperability
• CDS resource sharing collaboratives
Support • Patient-Centered Clinical Decision Support
• Promotion of Evidence-Based Practice adoption using CDS
• CDS Innovation Collaboratives
Future Direction of CDS Future Direction of CDS
• The Office of the National Coordinator for Health Information • OpenCDS
Technology (ONC)’s “Health Equity by Design” approach • OpenCDS is a multi-institutional, collaborative effort to develop
• ONC health IT certification - includes certain requirements for CDS open-source, standards-based clinical decision support (CDS) tools
functions, such as: and resources that can be widely adopted to enable CDS at scale.
• identification of diagnostic and therapeutic reference information, and
availability to the user of “source attributes” such as the developer of the
intervention, where clinically indicated, bibliographic citations, and funding
sources of the developer of the intervention.
• ONC is examining various approaches to ensure that users have the ability to
know how to apply algorithms in the right way, at the right time, and in the
right situations.
[Link] [Link]
Future Direction of CDS Future Direction of CDS
• Patient Centered Clinical • CDS Innovation Collaborative (CDSiC) – (AHRQ)
Decision Support • “The CDSiC aims to better understand what makes CDS patient-
• Patient Generated Health centered by serving as a proving ground of innovation, where we
Data (PGHD) develop resources to support developing, testing, implementing,
• Patient Reported Outcomes tracking, and measuring PC CDS in the real world.”
and Preferences
• Patient-specific info
• SDOH
[Link] [Link]