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201605 CDS Enablement Services

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Return to May 2016 Proposals

CDS Enablement Services

If creating a client, this track should require minimal work in advance of the connectathon, though at least a bit of preparation/reading on FHIR is recommended. If creating a server, advanced preparation will be required, but this scenario should somewhat limit the effort involved.

Pre-requisites: none

Submitting WG/Project/Implementer Group

Clinical Decision Support (CDS) with support from Service-oriented Architecture (SOA)


In order to provide effective and timely clinical decision support, a number of enabling infrastructure capabilities are necessary. This track explores and exploits capabilities available within the FHIR spec, and will illustrate how SOA services can complement these core capabilities as part of enablement of CDS.

Note that there is another CDS related track at this connectathon [1]

Proposed Track Lead

Coordinator: Claude Nanjo (Cognitive)

Expected participants

The expected participants include:

* Cognitive Medical System 
* Database Solutions
* Health Samurai
* Intermountain HealthCare
* OSIA Medical
* Partners Healthcare
* Regenstrief
* University of Utah


The CDS Enablement Service consists of four roles to support the proposed tracks:

SOA Services

  • A Publish and Subscribe Service which exposes interfaces for the registration of users and the association of users as subscribers and publishers to topics and for the management of topics.
  • A Unified Communication Service allowing communications directed towards human recipients and which supports functionality such as sending messages to recipients across various channels and escalating messages to other recipient.

SOA Service Clients

  • Publish and Subscribe Clients for the relevant interfaces of the Event Publish and Subscribe Service Functional Model such as publishing, subscribing, topic management, etc...
  • A Unified Communication Client that supports sending messages to the UCS broker and can query the UCS broker.


Publish & Subscribe Use Cases:

1. Register a new publisher

Precondition: EPS service is running


Publisher registers as a credentialed and identified publisher

Success Criteria:

Publisher successfully registered

2. Publish against a topic

Precondition: Successful registration of publisher


An event is published to designated topic

Success Criteria: Publisher successfully populates broker topic

Bonus Point: Broker implements ability for a published event to be moderated - i.e. held until approved

3. Subscribe to a specific topic

Precondition: Desired topic identified


Query available topics associated with the broker

Subscribe to one of the specific topics

Success Criteria:

Successfully establish a pull subscription

Bonus Point:

Successfully subscribe to a topic and receive push subscriptions

4. Receive a published event


Successful subscription


Server receives a request to publish an event on a topic

Server processes request and publishes the event to the topic

Success Criteria:

Successfully receive events from a pull subscription

Bonus Point:

Successfully receive events from a push subscription

5. Create a new topic


Successful registration, common topic tree, agreement on topic body


Review topic tree

Add new topic at the right point in the hierarchy

Success Criteria:

New topic appears on the topic tree

Bonus Point:

Support deferred topic create until topic parent owner approves insertion

Notify Care Team Use Cases:

1. Notify the primary care provider using EMR alert


A clinical process necessitates alerting a provider


Determine the notification payload to be sent

Determine addressing of recipient

Submit alert message to recipient

Success Criteria:

Primary care provider receives alert in "EMR" inbox

Bonus Point:

Use decision support to determine notification message

2. Select recipient based upon clinical role

Reroute (failover) message to provider along a different modality (e.g., eMail or SMS)


Original alert message sent to provider is not acknowledged in a timely manner.


Determine that message rerouting is required

Determine recipient addressing for a new communication channel

Submit message to recipient using alternative communication channel

Success Criteria:

Recipient receives message on the right device

Bonus Point(s):

Select alternative payload based on new communication channel and its HIPAA compliance

Select preferred modality based on recipient’s preference profile

3. Escalate message to next-in-charge via alert


Original alert message sent to provider is not acknowledged in a timely manner.

There is a named alternate (next-in-charge or surrogate) specified.


Determine that message escalation is required

Determine new recipient addressing for the alert

Submit message to proper recipient

Success Criteria:

Next-in-charge receives alert

Bonus Point:

Select escalation recipient based upon clinical role

Escalate to recipient using alternative communication channels