201601 CDS on FHIR Connectathon Track Proposal

CDS on FHIR

This Connectathon track has several goals.

First, this track aims to use the new KnowledgeModule resource and the accompanying Clinical Quality Improvement Framework (CQIF) IG to inform the direction of Clinical Quality work in FHIR. Specifically, we propose working with the various CDS-related initiatives currently being worked on in FHIR to help solidify the design of the KnowledgeModule and related resources and profiles.

Second, this track also aims to gather real-world implementer feedback on the CDS Hooks proposal from Josh Mandel to provide open clinical decision support using both FHIR and SMART.

Submitting WG/Project/Implementer Group

Several groups have joined together in asking for this track:

• Clinical Decision Support Work Group
• Clinical Quality Information Work Group
• Clinical Quality Framework Initiative
• A group of vendors and developers whom support the CDS Hooks proposal.

Justification

There is currently a lot of interest in the clinical quality community in how best to use FHIR to advance the goals of improving patient care through the effective use of quality measurement and intervention. At the same time, there are currently multiple approaches being used within the FHIR community, motivated by different use cases. This connectathon track will provide a vehicle for exploring how best to approach the implementation of these use cases in decision support and quality measurement scenarios.

Additionally, CDS Hooks allow for a very important use of both FHIR and SMART that is outside of the normal transactional flow of data. With CDS Hooks, EHRs can further integrate FHIR and SMART into the workflow with clinical decision support. Today, CDS Hooks have a relatively small visibility by the FHIR community as it is a fairly new proposal. With a track at a Connectathon, CDS Hooks would be exposed to the larger FHIR community, allowing others to see how FHIR can be used to provide clinical decision support in the EHR.

Proposed Track Leads

CQIF

• Bryn Rhodes
  • Email: bryn@databaseconsultinggroup.com
  • Skype: bryn.rhodes

CDS Hooks

• Kevin Shekleton
  • Email: kevin dot shekleton at cerner dot com
  • Skype: kevin.shekleton

Track Skype Chat

The CDS-on-FHIR Track has a Skype chat to coordinate preparation and participation in the track:

CDS-on-FHIR Connectathon Track Skype Chat

Expected participants

The following individuals and organizations will take part in the CQIF portions of this track:

• MITRE (possibly) in connection with the quality measurement scenarios/resources
• Partners Healthcare [Guidance Service]

The following individuals and organizations will take part in the CDS Hooks portion of this track:

• Cerner (Kevin Shekleton) [EHR, CDS Service]
• SMART Health IT (Josh Mandel) [EHR, CDS Service]
• Intermountain Health Care (Craig Parker) [CDS Service]
• RxREVU (Peregrin Marshall) [CDS Service]
• Premier, Inc (Kalyani Yerra) [CDS Service]
• Premier, Inc (Bill Harty) [CDS Service]
• Elsevier (David Yoshikawa) [CDS Service]
• Gajen Sunthara (Boston Children's Hospital) [CDS Service]

Roles

Guidance Service

A FHIR Server that implements the $guidance operation as defined on the KnowledgeModule resource.

Guidance Client

A client that consumes guidance from a FHIR Server using the $guidance operation.

EHR

The EHR will allow for the registration of interested CDS services on various CDS hooks, triggering each appropriately. The EHR will also display the CDS cards (obtained from the CDS services) to the user.

CDS Service

The CDS service will register themselves for the CDS hooks they are interested in and return CDS cards in response to trigger events as necessary.

Scenarios

CQIF

The Clinical Quality Improvement Framework Implementation Guide provides documentation for the resources that will be exercised by the Guidance Service and Guidance Client roles. Specifically, the following resources are utilized as part of those scenarios:

• ModuleMetadata
• DecisionSupportServiceModule
• GuidanceResponse
• $evaluate operation

IHE Radiology Guidance Request Scenario

Action: A Guidance Client issues a $guidance operation to a Guidance Service against the IHE Radiology Appropriateness Knowledge Module

Precondition: The GuidanceService must have the $guidance operation implemented and be able to process requests for the IHE Radiology Appropriateness Knowledge Module

Success Criteria: The Guidance Client receives an appropriately filled GuidanceResponse and the appropriate resources for the radiology request as described in the IHE Radiology Appropriateness IG.

Bonus point:

Price Check Guidance Request Scenario (cds-hooks)

Action: A Guidance Client requests a CMS Price Check from a Guidance Service

Precondition: The GuidanceService must have the $guidance operation implemented and be able to process requests for the CMS Price Check Knowledge Module

Success Criteria: The Guidance Client receives an appropriately filled GuidanceResponse and the appropriate actions describing the result of the price check as described in the CDS Hooks overivew.

Bonus point:

CDS Hooks

Display a CDS Information Card

Action: The EHR triggers a patient-view hook to the subscribed CDS Service whom returns a CDS information card.

Precondition: N/A

Success Criteria: The EHR displays the resultant CDS information card.

Bonus point: The CDS information card contains contextually relevant data about the patient based upon information about the patient from the FHIR server.

Display a CDS App Link Card

Action: The EHR triggers a patient-view hook to the subscribed CDS Service whom returns a CDS app link card.

Precondition: N/A

Success Criteria: The EHR displays the resultant CDS app link card and clicking the app link launches the desired SMART app.

Bonus point: The CDS app link card is only returned based upon contextually relevant data from the patient.

Display a CDS Suggestion Card to Cancel a Medication

Action: The EHR triggers an order-review hook to the subscribed CDS Service whom returns a CDS suggestion card to cancel the proposed order.

Precondition: A proposed order exists for the patient.

Success Criteria: The EHR displays the resultant CDS suggestion card to cancel the proposed order for the patient. If the user selects to accept the suggestion, the proposed order is canceled.

Bonus point: The CDS suggestion card is only returned based upon contextually relevant data from the patient. For instance, perhaps the medication is only suggested for cancellation if the patient is allergic to the medication.

Display a CDS Suggestion Card to Place a Medication

Action: The EHR triggers an order-review hook to the subscribed CDS Service whom returns a CDS suggestion card to create a new medication.

Precondition: A proposed order exists for the patient.

Success Criteria: The EHR displays the resultant CDS suggestion card to replace the proposed order for the patient with a new order. If the user selects to accept the suggestion, the proposal is accepted.

Bonus point: The CDS suggestion card is only returned based upon contextually relevant data from the patient. For instance, perhaps the medication is only suggested for replacement if a cheaper suitable medication is found.