201809 CDS Hooks

Return to September 2018 Proposals

CDS Hooks

Submitting WG/Project/Implementer Group

The CDS Hooks community, composed of vendors, developers, and CDS service providers whom support the CDS Hooks project.

Justification

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. Over the four Connectathon tracks, the CDS Hooks project has garnered immense support and interest from a variety of organizations. The CDS Hooks track is now consistently the most attended track at each Connectathon.

CDS Hooks has been presented at the American Medical Informatics Association (AMIA) 2016 Annual Symposium, the AMIA 2017 Annual Symposium, and the Argonaut Project chose CDS Hooks as a focus for 2017.

CDS Hooks was balloted as an STU for the 1.0 release during the May 2018 ballot cycle. The 1.0 specification is expected to be released prior to the September 2018 Connectathon. Holding a CDS Hook track at the September 2018 Connectathon will allow implementers to implement the released 1.0 specification as well as experiment with future additions to the specification.

Organizing a CDS Hooks track at the September 2018 Connectathon would allow the community to further develop and explore the possibilities with CDS Hooks. Holding another Connectathon track for CDS Hooks will further draw more developers and companies to HL7 and allow the community to work within the FHIR ecosystem. Additionally, the CDS Hooks community has found great benefit from participating in the Connectathons so continuing that participation would be appreciated.

Proposed Track Lead

Kevin Shekleton

• Email: kevin dot shekleton at cerner dot com
• Zulip: Kevin Shekleton

See Connectathon_Track_Lead_Responsibilities

Expected participants

• Cerner
• Epic
• CoverMyMeds
• many, many, more

Please sign up in the google sheet!

Roles

CDS Service

The CDS Service role provides real-time clinical decision support as a remote service. The CDS Server is invoked on a desired hook and returns the decision support in the form of CDS cards.

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.

Scenarios

1 - Implement 1.0 specification

Action: Both the EHR and CDS Service fully implement the 1.0 specification

Precondition: N/A

Success Criteria: TDB

Bonus point: N/A

2 - medication-prescribe hook: Check for Potential Drug-Drug Interactions

Action: With the medication-prescribe hook, the EHR sends a request that may include prefetch data to the CDS Service. The CDS Service may request additional data from the FHIR server then returns an array of Card(s) with associated suggestions.

Precondition: A prefetch or FHIR server query for contextual data element (below) resources (e.g., MedicationDispense, MedicationAdministration, MedicationRequest, MedicationStatement, Patient, Observation, Condition). Preference for obtaining medication resources with prefetch query.

Success Criteria: The EHR displays the appropriate Card response for the specified indicator element.

Bonus point: The EHR supports Card actions (i.e., create, update, delete) relevant to drug-drug interactions that may include canceling the current drug order, substituting the current drug order, discontinuing a historical drug, and adding an additional non-drug order (e.g., lab). The EHR supports parsing the DetectedIssue resource as an extension to the CDS Hooks Card Attributes. The EHR supports medication-select – defined as the step when the provider selects the drug product (i.e., ingredient and strength) during order entry.

Specific data elements for Connectathon use case include: Current medications, Historical medications, Age, Serum digoxin, Serum creatinine, Potassium, Magnesium, Calcium, and History of Upper Gastrointestinal Bleed.

3 - Opioid Guidance

TBD:

Contact: Ken Kawamoto

4 - medication-prescribe hook: Real Time Prescription Benefit

Action: With the medication-prescribe hook, the EHR sends a request that may include prefetch data to the CDS Service. The CDS Service may request additional data from the FHIR server then returns an array of Card(s) with real time benefit information about the prescription. This could include out of pocket cost at the pharmacy, deductible information and need to complete a prior authorization.

Precondition: A prefetch or FHIR server query for contextual data element (below) resources (e.g., MedicationRequest, Patient, Coverage). Preference for obtaining medication resources with prefetch query. FHIR Server queries will be made for Patient, Coverage, Practitioner (prescribing physician), Organization (patients preferred pharmacy & payor)

Success Criteria: The EHR displays the appropriate Card response for the specified indicator element.

Bonus Point: Validate authentication to the service using JWT (by default authentication will be disabled for the connectathon)

Specific data elements for Connectathon use case include:

MedicationOrder (DSTU2 Only)

• prescriber (reference to Practitioner)
• medication/code (ndc & rxnorm)
• dispenseRequest/quantity
• substitution/type

MedicationRequest (STU3 Only)

• requester/agent (reference to Practitioner)
• medication/code (ndc & rxnorm)
• dispenseRequest/quantity
• dispenseRequest/performer (reference to Organization - patient's preferred pharmacy)
• substitution/type

Patient (DSTU2 & STU3)

• birthDate
• name/given[0]
• name/family
• gender
• address/postalCode

Practitioner (DSTU2 & STU3)

• identifier (npi)
• name/family[0]
• address/city
• address/state
• address/postalCode

Coverage (DSTU2 & STU3)

• bin (DSTU2 only)
• plan (DSTU2 only)
• group (DSTU2 only)
• payor (reference to Organization - payor) (STU3 only)
• grouping/plan (ProcessorControlNumber) (STU3 only)
• grouping/group (Group ID) (STU3 only)
• identifier (Card Holder ID)
• relationship (STU3 only)
• dependent

Organization (payor) (STU3 Only)

• identifier (bin)

Organization (patient's preferred pharmacy) (STU3 Only)

• identifier (npi)

Use cases will utilizes specific values for the data elements above.

Contact: Jeremy Audino

5 - TDB

TDB - Details to follow

Connectathon Recap

TBD