Breast Cancer Screening and Management (BCSM) Clinical Decision Support (CDS) Implementation Guide - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Official URL: http://cancerscreeningcds.github.io/bcsm-cds/ImplementationGuide/cancerscreeningcds.fhir.us.bcsm-cds				Version: 1.0.0
Draft as of 2025-02-28				Computable Name: bcsmcds

Introduction

The Centers for Disease Control and Prevention's (CDC's) Division of Cancer Prevention and Control (DCPC) partnered with the CMS Alliance to Modernize Healthcare federally funded research and development center (Health FFRDC) on a multi-year effort to develop clinical decision support (CDS) tools. CDC and the Health FFRDC developed these tools to encourage awareness and adoption of the most up-to-date breast and colorectal cancer screening guidance and a risk-based approach for managing abnormal screening results.

The project team intends for the CDS to help clinicians provide screening and management care for breast and colorectal cancer based on updated guidelines from several organizations including the United States Preventive Services Task Force (USPSTF) for average risk screening guidelines and several others for managing higher than average risk patients and management of abnormal results.^{1 2} The Health FFRDC is developing the CDS using a reproducible process, utilizing interoperable health information technology (IT) standards including Health Level 7 International (HL7^®) Fast Healthcare Interoperability Resources (FHIR^®) and the Clinical Quality Language (CQL).

This document describes the purpose and intended use of the CDS for breast cancer screening and management (BCSM), options for integration of the CDS components with electronic health records (EHRs), and testing and verification for ensuring the CDS software performs as expected.

Purpose

The primary purpose of this implementation guide is to provide guidance to healthcare organizations regarding how to implement and operate the CDS tools for breast cancer screening and management (BCSM) in their EHR and evaluate their performance. In support of this activity, the document provides a description of the following areas:

• BCSM guidelines that informed the development of the CDS service and application displays
• BCSM integration with the clinical workflow to support patient care
• CDS design approach and dashboard display
• Semi-structured (i.e., human readable) logic, also referred to as Level 2 (L2) logic
• Structured (i.e., coded) logic, also referred to as Level 3 (L3) logic

Scope

This document provides guidance for end-users and implementors of CDS tools for breast cancer screening and management (BCSM) guidelines. It includes information about the project background, CDS design details, EHR integration, and use in a clinical setting.

Audience

Various audiences may find the information in this implementation guide helpful, including:

• Clinicians, Quality Improvement Leaders and Health Administrators at healthcare organizations and primary care practices who wish to implement, test, and execute CDS related to BCSM in their health IT systems.
• CDS Developers and Informaticists who may use components of this CDS logic as a foundation for other preventive health CDS, or who want to use well-developed structured logic and CQL in their own work.
• Community-based Organizations interested in using BCSM CDS tools to promote health and the importance of breast cancer screening and follow-up.
• Health IT Administrators interested in understanding how the BCSM CDS tools are specified to inform implementation of the CDS in their IT system.

Document Organization

This document is organized as follows:

• ​Section 2 – Background
• ​Section 3 – Specification
• ​Section 4 – Examples
• ​Section 5 – Downloads
• Section 6 – Artifacts