Designing effective Clinical Decision Support (CDS) tools in an Electronic Health Record (EHR) can prove challenging, due to complex real-world scenarios and newly-discovered requirements.  As such, deploying new CDS EHR tools shares much in common with new product development, where agile principles and practices consistently prove more effective than traditional project management. Typical agile principles and practices can thus prove helpful on CDS projects, including time-boxed sprints and lightweight requirements gathering with User Stories and acceptance criteria. Modeling CDS behavior removes ambiguity and promotes shared understanding of desired behavior, but risks analysis paralysis: an Agile Modeling approach can foster effective rapid-cycle CDS design and optimization. The agile practice of automated testing for test-driven design and regression testing can be applied to CDS development in EHRs using open-source tools. Ongoing monitoring of CDS behavior once released to production can identify anomalies and prompt rapid-cycle redesign to further enhance CDS effectiveness.
Using agile principles and practices, in calendar year 2015 our institution developed 58 EHR-based specialty patient registries, with 111 new CDS and data collection tools, supporting 134 clinical process and outcome clinical quality measures, and enrolling over 16,000 patients. Agile modeling proved key to joint understanding and communication during initial development--and to iteratively evolving CDS tools for optimal use in active clinical settings. The subset of UML and non-UML models found most consistently useful in designing, building, and iteratively evolving EHR-based Clinical Decision Support included User Stories, Domain Models, Use Case Diagrams, Decision Trees, Graphical User Interface Storyboards, Use Case text descriptions, and Solution Class Diagrams.

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About the Speaker(s)

Vaishnavi Kannan is a clinical decision support and population health specialist at the University of Texas Southwestern, where she designs and constructs advanced clinical decision support (CDS) products, patient registries, reports and dashboards. Vaishnavi iteratively developed the first MEWS (Modified Early Warning System) capability in UTSW’s electronic health record (EHR), with demonstrated impact on improving inpatient safety, and continues to advance its design. She works closely with clinicians and the Medical Informatics group on CDS design and patient registry development, providing expertise on the EHR’s clinical decision support and rules engine capabilities. In addition to her practice, Vaishnavi teaches agile modeling and iterative approaches for clinical decision support development to colleagues at UT Southwestern and at national conferences. Vaishnavi received an MS in Biotechnology at the University of Texas-Dallas, and subsequently completed a Health Information Technology certificate program at the University of Texas-Austin.

DuWayne Willett is the Chief Medical Informatics Officer (CMIO) at the University of Texas Southwestern Health System in Dallas. DuWayne led the initial design and implementation of the Health System Data Warehouse at UT Southwestern, and first become a student of agile methodologies through the Agile Data Warehousing movement to improve on the high failure rates common with traditional data warehouse projects. As the CMIO, DuWayne now oversees the design of UTSW Health System’s clinical information systems, and has been an advocate for adopting agile methodologies to electronic health record (EHR) optimization projects. DuWayne received his MD degree from the Medical College of Wisconsin, an MS in Information Systems from Drexel University in 2003, and a Master’s in Medical Management from the University of Texas at Dallas in 2007. His MSIS degree included course work on both structured and object-oriented analysis and design. DuWayne has taught courses on Health IT, process mapping, and UML modeling to Master’s and MBA students at UT-Dallas, and to medical students at UT-Southwestern, and works now to promote agile modeling and agile project management in healthcare IT.