# Presentation: 000313

## American Health

**American Health**
**Information Community**
**Personalized Health Care Workgroup**
**Report to Quality Workgroup**
**Understanding the Role of Clinical Decision Support in Personalized Health Care**
**Gregory Downing**
**ONC Lead, PHC Workgroup**
**October 3, 2007**

## PHC Workgroup Overview

**Broad Charge:**
- 	Make recommendations to the Community for a process to foster a broad, community-based approach to establish a common pathway based on common data standards to facilitate the incorporation of interoperable, clinically useful genetic/genomic information and analytical tools into electronic health records to support clinical decision-making for the clinician and consumer.
**Specific Charge:**
- 	Make recommendations to the Community to consider means to establish standards for reporting and incorporation of common medical genetic/genomic tests and family health history data into electronic health records, and provide incentives for adoption across the country including federal government agencies.

## Personalized Health Care (PHC) WorkgroupMember List

_**Co-Chairs:**_
- John Glaser		Partners HealthCare
- Douglas Henley		American Academy of Family Physicians
_**Staff Co-Chair:**_
- Gregory Downing	Office of the Secretary, HHS
_**Members:**_
- Carolyn Clancy 		Agency for Healthcare Research and Quality
- Beryl Crossley		American Clinical Laboratory Association, Quest
- Paul Cusenza		Consultant
- Andrea Ferreira-Gonzalez	Virginia Commonwealth University
- Becky Fisher		Patient Advocate
- Felix Frueh		Food and Drug Administration
- Emory Fry		Department of Defense
- Alan Guttmacher	National Institutes of Health/NHGRI
- Kathy Hudson		Genetics and Public Policy Center
- Betsy Humphreys	National Institutes of Health/NLM
- Charles Kennedy	WellPoint
- Joel Kupersmith	Department of Veterans Affairs
- Stephen Matteson	Pfizer
- Deven McGraw		National Partnership for Women and Families
- Amy McGuire		Baylor College of Medicine
- Mark Rothstein		University of Louisville
- Steve Teutsch		Merck
- Janet Warrington	Affymetrix
- Andrew Wiesenthal	Permanente Federation
- Marc Williams		Intermountain Healthcare
- Dennis Williams		Health Resources and Services Administration

## PHC Workgroup Senior Advisors

_**Senior Advisors:**_
- Mary Beth Bigley	Office of the U.S. Surgeon General
- Greg Feero		National Institutes of Health/NHGRI
- Joseph Kelly		Centers for Medicare & Medicaid Services
- Muin Khoury		Centers for Disease Control and Prevention
- Katherine Kolor		Centers for Disease Control and Prevention
- Michele Lloyd-Puryear	Health Resources and Services Administration
- Elizabeth Mansfield	Food and Drug Administration
- Clement McDonald	National Institutes of Health/NLM
- Armando Oliva		Food and Drug Administration
- Dina Paltoo		National Institutes of Health/NHLBI
- Jonathan Perlin		HCA, Inc.
- Gurvaneet Randhawa	Agency for Healthcare Research and Quality
- Lisa Rovin		Food and Drug Administration
- Maren Scheuner	RAND Corporation
- Jean Slutsky		Agency for Healthcare Research and Quality
- Reed Tuckson		UnitedHealth Group; SACGHS
- Mollie Ullman-Cullere	Harvard Partners Center for Genetics and Genomics
- Grant Wood		Intermountain Healthcare

## PHC Vision and Priorities

- Personalized Health Care is a consumer-centric system in which clinicians customize diagnostic, treatment, and management plans
- Four perspectives were identified as important to the vision
- Consumer
- Clinician
- Researcher
- Health Plan/Payer
- Four priority areas across each perspective
- Genetic/Genomic Tests
- Family Health History
- Confidentiality, Privacy, and Security
- Clinical Decision Support

## Why Address Clinical Decision Support (CDS)?

- Consumer-clinician interactions can be augmented by CDS tools
- The data involved in PHC is complex
- Deployment of genetic technologies into mainstream health care will depend on CDS tools
- Genetic/Genomic Tests and Family Health History
- Recommendation that a PHC Use Case be developed to address these two aspects was accepted at the July 31, 2007 AHIC meeting
- Confidentiality, Privacy, and Security
- Background documents and recommendations will be advanced to the CPS Workgroup in the next several months
- Clinical Decision Support
- Work with ONC, AHIC to address common goals and applications

## How did the PHC WG Approach CDS?

- Visioning Session (March-April, 2007)
- CDS will be needed to facilitate evidence-based decisions by clinicians and consumers related to genetic information
- Risk assessment algorithms, predictive tools, and prevention messages will increasingly use genetic information
- Incentives for development of CDS to support PHC
- Staff Activities/Background work (June-July, 2007)
- Examined commercially available CDS tools, systems that are deploying CDS across their organization
- Coordinated fact finding with CDS Roadmap team
- Developed background papers on resources, issues
- AHIC/ONC Activities (June-present)
- Working with internal CDS team to ensure coordination of activities
- AHRQ Activities
- Products from previous work/projects
- New RFP solicitation

## Planning for PHC CDS Activities

- PHC Workgroup meeting on CDS: September 17, 2007
- Moderated by Jonathan Teich and Jerry Osheroff
- All day, in person in Washington, DC
- Meeting Agenda:
- Panel 1: CDS Tools – Services and Systems
- Case Study: CDS for Pharmacogenomics-Guided Warfarin Dosing
- Panel 2: Evidence Development for CDS
- Assumptions prior to the meeting
- The concepts and deployment of CDS tools and systems are still early in development
- Identified clinically useful, web-based CDS tools but not embedded in electron health records
- There are many complex and challenging issues involved in the development of useful CDS tools
- There is a high demand for CDS tools to support PHC
- CDS is recognized as a critical, and substantial unmet need

## PHC Workgroup Findings on CDS

- PHC Workgroup meeting on CDS: September 17, 2007
- Findings
- Many of the CDS developers had funding or important interactions with AHRQ
- Patient engagement and inclusion of patient preferences in CDS configurations will be critical in order to truly personalize healthcare
- Focus on CDS applications for primary/ambulatory care
- CDS tools could be used to empower the consumer
- Design of CDS tools to fit into natural workflow is of high importance
- Examine the use of standards or a national repository to maximize efforts and widely deploy evidence
- Look for potential pilot studies or existing examples of repositories of best practice guidelines

## Potential Future CDS Activities for AHIC WGs

- Examine a shared decision-making model to connect the consumer and clinician
- Examine CDS tool use in a chronic-care and prevention settings
- Can best practices for workflow in CDS tools be developed?
- How do we build individual variations into widely deployed systems?
- Use the CDS roadmap to consider establishing a national repository of best practices in a standardized way
- Examine how to present new and old knowledge in a consistent way
- Discuss various CDS issues during the October and November workgroup meetings
- Examine potential areas of early success
- Family history tools, breast cancer risk assessment, newborn screening
- See how existing CDS tools can be deployed across EHR systems
- Use findings in use case development