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Composite KNART Questions

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Questions to be explored include (but are not limited to):

  • Definition of common elements that apply to the entire composite
  • How to harmonize / de-duplicate elements, particularly across related Order Sets, and in the presence of co-morbidities. This includes managing elements that are actually duplicates as well as elements that are subsets or supersets of each other. For example, one constituent Order Set might require laboratory tests including a Basic Metabolic Panel (BMP), and another in the composite requires a Comprehensive Metabolic Panel (CMP). The combined request must result in only one instance of the order(s) that appear in both, and may mean that only the comprehensive panel is ordered.
  • How member order sets are related to each other and to other KNARTS in the composite.
  • Potential extension of KNARTs for relationship with other KNARTs, and the related metadata
  • Review technology bindings (CQL, etc) and potentially incorporate new release
  • Assess potential extension of artifact types and potential classification by purpose
  • Address identified issues in Events and Action specification and organization
  • Explore specification of post-coordinated concepts across terminologies
  • Versioning and life cycle management
    • potentially consider STAMP as an approach
  • Consider the impact of adjusting from the current XML-based KNARTs to newer FHIR-based Clinical Reasoning Resources

Clarifications:

  • Definition of conceptual model for knowledge artifacts?
    • composability
    • binding to information and behavioural models
    • mechanisms for execution, inter-referencing and communication
  • management of knowledge artifacts
  • representation and packaging
  • opacity and inclusion dynamics
  • metadata to identify the appropriate context of use to support safe sharing of knowledge artifacts
    • support for digital signing and provenance
    • syntactic and semantic validation
  • should other types of knowledge artifacts be incorporated
    • hierarchies of clinical models; fhir profiles; ontologies for example
    • information displays; data displays
    • Infobutton
    • workflow / execution knowledge
    • performance measure with attribution - physician, care team, hospital,
  • Relationship to C-CDA and C-CDA on FHIR