Migrating toward a next-generation clinical decision support application: the BJC HealthCare experience

The next-generation model outlined in the AMIA Roadmap for National Action on Clinical Decision Support (CDS) is aimed to optimize the effectiveness of CDS interventions, and to achieve widespread adoption. BJC HealthCare re-engineered its existing CDS system in alignment with the AMIA roadmap and plans to use it for guidance on further enhancements. We present our experience and discuss an incremental approach to migrate towards the next generation of CDS applications from the viewpoint of a healthcare institution. Specifically, a CDS rule engine service with a standards-based rule representation format was built to simplify maintenance and deployment. Rules were separated from execution code and made customizable for multi-facility deployment. Those changes resulted in system improvement in the short term while aligning with long-term strategic objectives.