Sustainability Proposal

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Executive Summary

Today there is a fragmented ecosystem comprised of biomedical knowledge generators, vendors, consumers, regulators—and more—for clinical decision support (CDS). The fragmented ecosystem hinders health care organizations, providers, and patients (increasingly so), from utilizing the best and most current knowledge in their health-related decisions for individual patients as well as patient populations. For example, the Centers for Disease Control released its testing guidelines for Zika and Dengue Fever in June 2019 and then updated them again in November 2019, yet fragmentation in the CDS ecosystema has the potential to delay doctors and their patients from receiving that updated information at the point-of-care in clinics and hospitals. Relatedly, a recent review of hypertension guidelines found that leading clinical practice guidelines (CPGs) were highly inconsistent in their recommendations; which demonstrates the inconsistencies in today’s CDS ecosystem for making the right knowledge available to the right people at the right time.

A more robust CDS ecosystem could address the above example by establishing and spreading software standards that enable all stakeholders to format and deliver their guidance in executable forms, which healthcare organizations, doctors, and patients could download or access from their electronic health records or potentially into smartphone apps. A more robust CDS ecosystem would address guideline inconsistencies by providing forums for knowledge developers to better determine gaps—or conflicts—in their recommendations and provide tools that highlight those gaps and help to resolve them. A more robust CDS ecosystem would contribute to larger efforts to transform today’s healthcare system.

There is a growing acknowledgment among CDS developers, guideline developers, healthcare organizations, policymakers—and others—that to more effectively and efficiently leverage the best knowledge for health decision-making, there needs to be a more cohesive and standards-based CDS ecosystem than what exists today. The Learning Network proposes establishing a Knowledge Network as a successor to the Learning Network to guide the development of a cohesive and standards-based ecosystem. The Knowledge Network will take advantage of a growing consensus among stakeholders in the CDS ecosystem that a pre-competitive entity, effectively governed and collaborative in nature, can foster the availability and use of computable biomedical knowledge that improves patient health, and healthcare delivery, at lower costs and with lower burden on providers. Such an entity could help bring to life the vision of a Learning Health System and manifest the value that has been long-expected from the United States’ investments in electronic health record adoption.

For the full proposal, see link below.

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