Summary of fourth annual MCBK public meeting: Mobilizing computable biomedical knowledge-metadata and trust.

The exponential growth of biomedical knowledge in computable formats challenges organizations to consider mobilizing artifacts in findable, accessible, interoperable, reusable, and trustable (FAIR+T) ways1. There is a growing need to apply biomedical knowledge artifacts to improve health in Learning Health Systems, health delivery organizations, and other settings. However, most organizations lack the infrastructure required to consume and apply computable knowledge, and national policies and standards adoption are insufficient to ensure that it is discoverable and used safely and fairly, nor is there widespread experience in the process of knowledge implementation as clinical decision support. The Mobilizing Computable Biomedical Knowledge (MCBK) community formed in 2016 to address these needs. This report summarizes the main outputs of the Fourth Annual MCBK public meeting, which was held virtually July 20 to July 21, 2021 and convened over 100 participants spanning diverse domains to frame and address important dimensions for mobilizing CBK.

Learning health systems, embedded research, and data standards-recommendations for healthcare system leaders.

Learning health systems that conduct embedded research require infrastructure for the seamless adoption of clinical interventions; this infrastructure should integrate with electronic health record (EHR) systems and enable the use of existing data. As purchasers of EHR systems, and as critical partners, sponsors, and consumers of embedded research, healthcare organizations should advocate for EHR system functionality and data standards that will increase the capacity for embedded research in clinical settings. As stakeholders and proponents for EHR data standards, healthcare leaders should support standards development and promote local adoption to support quality healthcare, continuous improvement, innovative data-driven interventions, and the generation of new knowledge. "Standards-enabled" health systems will be positioned to address emergent and critical research questions, including those related to coronavirus disease 2019 (COVID-19) and future public health threats. The role of a data standards officer or champion could enable health systems to realize this goal.

A Closer Look at the "Right" Format for Clinical Decision Support: Methods for Evaluating a Storyboard BestPractice Advisory.

(1) Background: The five rights of clinical decision support (CDS) are a well-known framework for planning the nuances of CDS, but recent advancements have given us more options to modify the format of the alert. One-size-fits-all assessments fail to capture the nuance of different BestPractice Advisory (BPA) formats. To demonstrate a tailored evaluation methodology, we assessed a BPA after implementation of Storyboard for changes in alert fatigue, behavior influence, and task completion; (2) Methods: Data from 19 weeks before and after implementation were used to evaluate differences in each domain. Individual clinics were evaluated for task completion and compared for changes pre- and post-redesign; (3) Results: The change in format was correlated with an increase in alert fatigue, a decrease in erroneous free text answers, and worsened task completion at a system level. At a local level, however, 14% of clinics had improved task completion; (4) Conclusions: While the change in BPA format was correlated with decreased performance, the changes may have been driven primarily by the COVID-19 pandemic. The framework and metrics proposed can be used in future studies to assess the impact of new CDS formats. Although the changes in this study seemed undesirable in aggregate, some positive changes were observed at the level of individual clinics. Personalized implementations of CDS tools based on local need should be considered.