Overall Objectives and Rationale

Clinical decision support (CDS) “provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.” CDS is one of the most critical components of health information systems because CDS interventions can improve patient outcomes and lead to higher-quality health care. With the adoption of electronic health record (EHR) systems reaching over 90% of health care settings in the U.S., unprecedented opportunities exist to improve the quality and value of health care through CDS interventions at the national scale. However, to improve patient outcomes, increase clinician efficiency, and reduce clinician burnout, CDS tools need to be designed and implemented according to best practices and disseminated across healthcare settings through standards-based approaches.

Course Goal

Taught by national leaders with decades of practical experience in the design, development, implementation, and evaluation of CDS, this online and hands-on course teaches state-of-the-art principles and best practices to enable effective CDS. Topics include a review of the various types of CDS tools; principles of CDS governance and knowledge management; CDS technical architectures, standards (e.g., FHIR, SMART, CDS Hooks, Infobutton), and tools (OpenInfobutton, OpenCDS); and CDS implementation and evaluation. The course has been offered for over 20 years as a part of the graduate program at the University of Utah Department of Biomedical Informatics, which has a five-decade long history of innovations in CDS.

Target Audience

The course is targeted at any individual who is interested in CDS, regardless of background or prior experience. The student cohort is multidisciplinary, with backgrounds in health care delivery, public health, computer science, biology, genetics, and information technology. Examples of roles that could benefit from this course include those engaged with CDS governance and implementation at health care or public health organizations, CDS designers/developers, health IT designers/developers, CDS researchers, and clinical/health services researchers interested in applying CDS in their research.

Course Structure Overview

This is a 16-week long, three credit-hour course organized in 14 modules. Each module covers a specific topic and includes recorded presentations, reading materials, a short weekly quiz, and a synchronous lab session. In addition, the course has three assignments and a semester-long group project. Weekly lab sessions are offered on Tuesdays at 7pm ET. Students can join either onsite at the Department of Biomedical Informatics or remotely via Web meeting. Lab sessions are recorded and posted to Canvas for those who cannot attend.

Course Outline

Course Outline – August - December 2021

Module #	Module Title
Module 1	Course overview, introduction to clinical decision support
Module 2	Effectiveness of CDS
Module 3	Workflow implications and Infobuttons
Module 4	CDS Governance and knowledge management
Module 5	Knowledge engineering
Module 6	CDS architecture and related standards
Module 7	Implementation and evaluation
Module 8	CDS for diagnostics support
Module 9	Patient-centered decision making
Module 10	CDS for population and public health
Module 11	Artificial Intelligence (AI) and CDS
Module 12	CDS: achieving the mission
	Group project – CDS system delivery and presentation
	Final exam

Logistics

Canvas, the University of Utah’s online teaching resource, is used to manage the course. Students will be given instructions to use Canvas after they enroll. All course materials, activities, and communication are delivered through Canvas.

Evaluation

Graduate-level thinking, writing, and independent study will be expected.

To satisfactorily complete the course, students need to obtain a grade of 80% (B-) or better. The final grade is composed of the following output:

• • 15% Weekly quizzes
  
• • 15% Online discussions
  
• • 10% Lab session attendance
  
• • 40% Group project (includes sub-deliverables)
  
• • 20% Final exam

Evaluation components:

1) Weekly quizzes
We will test content with a short quiz every week. The aim of these quizzes is for students to demonstrate that they have engaged and learned the material. The quiz will be a mix of question types and will focus on the most important material covered each week. The quizzes will be open-book. Students will have a single 1-hour session to complete the quiz. The quiz must be completed within the hour once started.

2) Online discussions
To facilitate participation and critical thinking among students, there will be a discussion question posted on the ‘Discussions’ section of the online learning platform. These questions will generally be opinion questions in which there is no right or wrong answer. The discussion board is mainly designed to stimulate students to think and research a particular topic and engage with other learners in the course. The initial response must be at least 250 words and MUST be posted by the end of the first week of each discussion topic. Each student will be required to respond to at least one additional learner in the discussion area the week following the original posts. Responses should be at least 50 words in length and be more than a simple “I agree” or “Good post”.

3) Synchronous lab sessions
Synchronous lab sessions to work through case studies or present and get feedback on the group project occur throughout the semester to help the students obtain additional understanding on a topic. Students must attend (and participate) in at least 5 lab sessions. Participation in all sessions is very highly recommended. NOTE: the final group project presentation is not included in this count.

4) Group project
Throughout the course, students work in multidisciplinary teams to propose, design and implement a functioning prototype of a standards-based CDS. Each team is assigned to a faculty mentor. The project is broken down into five deliverables that are graded independently. Students will need to meet outside course times to complete the project. Attendance in the final presentation is required (unless permission is given prior to the session to be excused).

5) Final exam
The final exam will be open book, but assistance or communication (verbal, electronic, or otherwise) with anyone else (fellow class members or not) is not allowed. The exam will be administered via Canvas at the end of the course. Students will have a set time to complete the exam once started. There will be only one chance to start and finish the exam. The exam will be a mix of questions: multiple choice, fill in the blank, short answer, etc. The questions address the material covered in lectures, readings, discussion boards, quizzes, and assignments.

Learning Objectives

At the completion of the course, students will be able to:

• • Describe different kinds of CDS tools and their relevance to clinical problems.


• • Apply current CDS architectures, standards and tools such as SMART on FHIR, CDS Hooks, HL7 Infobutton Standard, OpenInfobutton, and OpenCDS.


• • Develop a CDS tool following best CDS design practices.


• • Describe the challenges with effective CDS implementation and adoption, including potential pitfalls such as alert fatigue.


• • Plan the implementation and evaluation strategy for a CDS intervention.

The course has no required textbook.