201605 CQF on FHIR Connectathon Track Proposal
CQF on FHIR
This track is intended to exercise several scenarios related to clinical quality that will exercise the resources defined by the Clinical Decision Support and Clinical Quality Information Work Groups.
Submitting WG/Project/Implementer Group
- Clinical Decision Support Work Group
- Clinical Quality Information Work Group
- Clinical Quality Framework Initiative
Justification
The CDS and CQI Work Groups are incorporating feedback from previous ballots, the prior connect-a-thon, as well as other work groups to refine and improve the structures used to enable the representation and evaluation of quality artifacts using FHIR. This effort has resulted in a combined CQF IG that will be balloted in the May cycle. The scenarios in this connect-a-thon track proposal are intended to support that ballot by exercising key resources and use cases in the IG.
Proposed Track Lead
- Bryn Rhodes
- Email: bryn at databaseconsultinggroup dot com
- Skype: bryn.rhodes
Expected participants
- Partners Healthcare [Immunization Guidance Scenario]
- Cognitive Medical Systems
- University of Utah Healthcare
- ESAC, Inc
- PenRad
- Health Ally
Roles
Guidance Service
The Guidance Service role provides real-time clinical decision support services. This component enables a consumer to request clinical decision support based on the current context. The consumer provides relevant contextual information as part of the request, and receives clinically relevant guidance as a set of resources describing potential actions to be taken.
Guidance Client
The Guidance Client role consumes real-time clinical decision support services. The client integrates decision support at the appropriate point in a given workflow, allowing the user of the system to respond to the guidance presented by the decision support system.
Knowledge Management Repository
A FHIR Server that implements search and retrieval functionality for the various quality artifact resources.
Knowledge Artifact Consumer
A system that consumes knowledge artifacts from a knowledge management repository
Measure Reporting Service
A system that provides measure evaluation results
EPS Subscriber
An agent that subscribes to events published by an Event Publish Subscribe (EPS) system
UCS Client
A client to a Unified Communication System (UCS)
Order Set Service
A service capable of evaluating order set definitions to produce order sets applicable to a specific patient and/or context.
Order Set Client
A client capable of requesting the evaluation of an order set definition for a specific patient and/or context, and consuming the resulting order set instance.
Scenarios
The Clinical Quality Framework Implementation Guide provides documentation for the resources that will be exercised by the above roles. Specifically, the following resources are utilized as part of those scenarios:
IHE Radiology Guidance Request Scenario
- Action: A Guidance Client issues an $evaluate operation to a Guidance Service against the IHE Radiology Appropriateness Decision Support Service Module
- Precondition: The GuidanceService must have the $evaluate 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:
CDC Immunization Guidance Scenario
- Action: A Guidance Client issues an $evaluate operation to a Guidance Service against the CDC Immunization Decision Support Service Module. The parameters to the module are:
- patient - The patient for which immunization guidance will be returned. The birthDate and gender should be provided.
- organizationId - The Id of the requesting organization. For the purposes of this connect-a-thon, use the hardcoded value 'FHIR_CONNECT_A_THON'
- Precondition: The GuidanceService must have the $evaluate operation implemented and be able to process requests for the CDC Immunization Decision Support Service Module.
- Success Criteria: The Guidance Client receives appropriate immunization guidance based on the patient information provided in the request. The service provides guidance using the current CDC Immunization Guidelines. The test script is written with a male infant and receives an appropriate immunization schedule as ImmunizationRecommendation resources.
- Bonus point: Handle error scenarios including:
- Unauthorized: Perform the request with an invalid organization ID
- Incomplete: Perform the request without providing birth date or gender. The response will still provide an immunization schedule, but with appropriate warnings about the use of clinical judgement in administering immunizations.
- Malformed: Perform the request with invalid data. The response will be an OperationOutcome with an appropriate description of the error that occurred.
Knowledge Management Repository
- Action: A Knowledge Artifact Consumer uses a Knowledge Management Repository to locate and retrieve a decision support rule, order set, library, and measure related to a specific condition.
- Precondition: The Knowledge Management Repository must contain the artifacts and be able to respond to the search requests.
- Success Criteria: The Artifact Consumer receives the knowledge management artifacts and is able to use them to drive decision support and quality measurement within their system.
Measure Reporting Service
- Action: A Measure Reporting Service uses a previously retrieve knowledge artifact definition to drive measure evaluation and reports the results using the MeasureReport resource.
- Precondition: The Measure Reporting Service has ingested a measure retrieve from a knowledge management repository.
- Success Criteria: The MeasureReport result contains the results of evaluating the measure, and there is evidence within the reported results of having followed the related decision support artifacts at the point of care.
CQF-SOA Integration
This scenario involves orchestration of services to illustrate the use of various existing and emerging HL7 standards, including FHIR and CQF-on-FHIR, to faciltate evidence-based care.
In this scenario, an abnormal lab result is reported for a patient. This results in the EHR surfacing an event through the EPS system. The EPS Subscribers handles this event by invoking an appropriate Decision Support Service Module via a Guidance Service. The EPS Subscriber receives guidance in the form of a CommunicationRequest, and invokes the UCS to complete the communication. The communication consists of a request for the provider to consider application of a specific Order Set. The care provider uses a UCS Client to view the communication, resulting in the use of an Order Set Service which provides appropriate guidance to select the orders to be placed.
This scenario makes use of the following components:
- EPS - Event Publish/Subscribe service as described by the SOA EPS track
- EPS Subscriber
- Guidance Service
- UCS - Unified Communication System service as described by the SOA UCS track
- UCS Client
- Order Set Service
- Order Set Client
This scenario consists of the following steps:
- An EPS system surfaces an abnormal lab result event
- An EPS Subscriber subscribed to the "abnormal lab result event" issues a request for guidance based on the abnormal lab result
- The EPS Subscriber receives guidance in the form of a CommunicationRequest, recommending that the patient's care provider should consider a particular order set.
- The EPS Subscriber issues the CommunicationRequest to the care provider via the UCS
- The UCS notifies the care provider via the appropriate channel
- The care provider opens the communication request in a UCS client
- The care provider follows the recommendation by preparing an order set using an order set service
- The care provider places the resulting order with an ordering service
- Evaluation of a measure showing impact of the order
