This document outlines the implementation and evaluation plan for a revised clinical decision support (CDS) tool to improve colorectal cancer screening. The plan involves key informant interviews and observation to inform the tool's design. It will undergo rapid prototyping, simulation testing, and implementation in two primary care clinics. The impact will be evaluated based on efficiency, usability, and workload measures compared to existing tools in other clinics. Implementation teams will apply lean process methods like identifying barriers and testing future workflows to integrate the new CDS tool.

1. Implementation and Evaluation of Revised CDS Tool January 8 th , 2008 LEADERS SYMPOSIUM “ Strategic Planning to Inform a Funded Project on how to Achieve Workflow Integration in Developing and Implementing CDS for CRC Screening”

2. Key Informant Interviews of site-specific best-practices for integration of colorectal cancer screening CDS into workflow Direct Observation of colorectal cancer screening CDS for barriers and facilitators to workflow integration Implementation in primary care clinic after simulation study Rapid Prototyping of CDS design alternatives based on Phase 1 findings Simulation Study to test impact of CDS design alternatives on efficiency, usability, and workload Evaluation in primary care clinic after simulation study Figure. Project Overview Phase 1 Phase 2 Phase 3

6. Lean Process Design… Identifying and Eliminating Operational Barriers within Patient Treatment Processes Materials Step 3

9. Implementation Teams in Action Courtesy Peter Woodbridge

12. Lean Tools Develop Future State Process Process Control Strategy Baseline Current Processes Identify Operational Barriers Define the Problem Process Observation Worksheet Spaghetti Diagram 5S, Visual Controls, Constraint Management Process Map Check sheet Process Control Plan Project Charter Voice of the Customer

14. PDSA Plan PDSA Do Study Act Plan the process change, collect Baseline Output data Try out the test, collect Output data from the new process Examine the process/data to determine failure modes Refine the test, based on failure modes

15. Where is PDSA used within the Lean Cycle? Develop Future State Process Process Control Strategy Baseline Current Processes Identify Operational Barriers Define the Problem PDSA PDSA PDSA