201701 Clinical Reasoning Track

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Clinical Reasoning Track

This track defines several scenarios related to clinical quality that exercise the resources defined by the Clinical Decision Support and Clinical Quality Information Work Groups, as well as profiles and usage guidance defined in the Clinical Quality Framework Implementation Guide.

This track will coordinate with:

• Care Plan - Care Plan Creator Role

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, prior connect-a-thons, as well as other work groups to refine and improve the structures used to enable the representation and evaluation of quality artifacts using FHIR. These efforts have resulted in several resources and related implementation guides that will be balloted both as part of the FHIR STU 3 ballot and as separate implementation guides in the upcoming September 2016 ballot 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 implementation guides.

Proposed Track Lead

• Bryn Rhodes
  • Email: bryn at databaseconsultinggroup dot com
  • Skype: bryn.rhodes

See Connectathon_Track_Lead_Responsibilities

Expected participants

• National Comprehensive Cancer Care Network (NCCN)
• Evinance
• ESAC, Inc.
• HarmonIQ Health Systems Corporation
• University of Utah

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 appropriate points in clinical workflow, allowing users 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

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.

Measure Reporting Service

A system that provides measure evaluation results

Scenarios

The Clinical Reasoning Module provides documentation for the resources that will be exercised by the above roles. Specifically, the following resources are utilized as part of those scenarios:

• ActivityDefinition
• GuidanceResponse
• Library
• Measure
• PlanDefinition
• RequestGroup
• ServiceDefinition

Scenario Step 1 Name

Action:

Precondition:

Success Criteria:

Bonus point:

NCCN Chemotherapy Regimen Scenario

In this scenario, a Knowledge Artifact Provider defines and distributes an NCCN Chemotherapy Regimen to a Knowledge Artifact Consumer.

Create an Order Template

Action:

Precondition:

Success Criteria:

Bonus point:

Search for an Order Template

Action:

Precondition:

Success Criteria:

Bonus point:

Ingest an Order Template

Action:

Precondition:

Success Criteria:

Bonus point:

Apply an Order Template for a specific patient

Action:

Precondition:

Success Criteria:

Bonus point:

Determine Adherence (On/Off Protocol)

Action:

Precondition:

Success Criteria:

Bonus point:

Zika Virus Reporting Scenario

In this scenario, a patient presents at the point-of-care, and Zika Virus management is triggered if the patient is a woman of child-bearing age. As an alternative, Zika Virus management may be triggered by a mobile application that detects travel to an area where Zika exposure is an identified risk.

Payer Extract Scenario

In this scenario, a Payer uses a Measure Processing Component to extract relevant data from an EHR to enable computation of payer quality measures.

Single Measure Individual Open Access

Action: A Payer issues an $evaluate-measure operation to a Measure Processor to determine required patient information. The inputs to this operation are:

• Measure to be evaluated (this is part of the url of the request)
• Patient Id
• Last Retrieved On (the date the data was last retrieved, only data that is new/updated since this date should be returned)

Precondition: The EHR must be prepopulated with information for the given patient that satisfies the requirements of the measure being evaluated.

Success Criteria: The Payer receives a MeasureReport with the url to a Bundle containing the required patient information.

Bonus point: Use the Last Retrieved On parameter in successive executions to demonstrate incremental data exchange

Three cohort definition measures are supported for this scenario:

• Controlling Blood Pressure (Observation resources conforming to the DAF-Vital Sign profile, blood pressure measurements)
• Adult BMI Assessment (Observation resources conforming to the DAF-Vital Sign profile, height and weight measurements)
• Colorectal Cancer Screening (Condition, Procedure, and Observation resources)