Introduction
The Health Services Research and Development (HSR&D) Center for Health Care Evaluation (CHCE) has been a leader among the HSR&D Centers of Excellence in the development and implementation of decision support systems to improve care for VA patients. In prior collaboration with experts in the SMI/KMG, Dr. Mary Goldstein and colleagues developed an innovative automated clinical DSS (ATHENA; see Goldstein et al., 2000; 2002; in press). The system uses an extensive knowledge base of guideline and relevant drug information, together with individual patient data from the VA’s electronic medical record system, VistA, to generate individualized recommendations for the management of hypertension. These recommendations are displayed to clinicians in a pop-up window in the VA CPRS. By cobbling funds from multiple sources, Dr. Goldstein was able to obtain support from the SMI/KMG to develop ATHENA. However, the knowledge transfer between SMI/KMG and VA staff was limited and, with the exception of two workshops, did not extend beyond the ATHENA team. This Grant allows support for broader, more in-depth knowledge transfer in terms of both topics covered and the number of VA staff who are trained/mentored.
The ATHENA Opioid Therapy project has been underway since November, 2003, with Dr. Denise Daniels as the Principal Investigator. The goals are to design, develop, and implement a DSS based on the VA/DoD clinical practice guidelines entitled “VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain.” The Guideline can be found at: http://www.oqp.med.va.gov/cpg/cot/ot_base.htm
This project will use the modular technology applied in ATHENA. Training and mentoring by Stanford KMG experts, and the use of the software applications and tools already developed by the KMG, will substantially reduce development time of this and other new DSSs in CHCE.
The current reengineering of VistA/CPRS affords an opportunity to ensure a VA clinical information infrastructure that facilitates the implementation of automated DSSs. This goal can be accomplished if uniform methods of retrieving and updating patient information, and a standardized process for transmitting practice recommendations, can be incorporated in the reengineering process. Thus, as a secondary focus, we propose to facilitate communication between SMI/KMG experts and VA OI staff to enhance the likelihood that automated clinical decision support can be incorporated within the reengineered informatics infrastructure.
Specific Aims
The primary aims of an Academic Partner Supplement for CHCE are to (1) facilitate conceptual knowledge transfer between SMI/KMG experts and VA investigators and project managers in issues underlying the development and implementation of DSSs that can be integrated with VA technology, and (2) facilitate technological knowledge transfer between SMI/JKMG experts and (a) “knowledge modelers” on the use of PROTÉGÉ for encoding practice guidelines, and (b) IT professionals, such as programmers and software engineers, on the use of EON technology and software tools, and on interfacing DSSs with the VA medical information system. A secondary aim is to enhance the likelihood that the VA medical informatics infrastructure (i.e., the re-engineered VistA and CPRS) readily accommodates DSSs by fostering interactions between the SMI/KMG experts and staff in the VA OI.
