201801 CDS Hooks
Submitting WG/Project/Implementer Group
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. At the Connectathon in San Diego (Sept 2017), we had participation from 4 EHR vendors, many more CDS service providers, and 32 developers.
CDS Hooks has been presented at the American Medical Informatics Association (AMIA) 2016 Annual Symposium, the AMIA 2017 Annual Symposium, and the Argonaut Project has chosen CDS Hooks as a focus for 2017.
Organizing a CDS Hooks track at the January 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
- Email: kevin dot shekleton at cerner dot com
- Zulip: Kevin Shekleton
- University of Utah - OpenInfobutton
- many, many, more
Please sign up in the google sheet!
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.
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.
Implement 1.0 spec
- Action: Both the EHR and CDS Service fully implement the 1.0 spec (includes security)
- Precondition: N/A
- Success Criteria: TDB
- Bonus point: N/A
Display a CDS suggestion card with links to relevant resources and a CDS App Card showing condensed results of a SMART app called “Clinical Knowledge Summary” (CKS) with a link to launch the app
- Action: The EHR triggers either a patient-view hook or a medication-prescribe hook to the subscribed CDS Service, which returns a CDS suggestion card and/or an card with condensed search results and a link to the SMART app
- Precondition: An EHR user opens up a patient’s chart or enters a medication prescription
- Success Criteria: The EHR displays (1) a suggestion card with links to patient education materials in MedlinePlus and drug monographs within UpToDate; and an app card with the number of Systematic Reviews and Clinical Trials found by the CKS app along with a link that successfully launches the app with the appropriate search results.
- Bonus point: The CDS suggestion card is only returned when results are found.
Implement Potential Drug-Drug Interaction check using 1.0 spec
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 Card response as a modal alert (i.e., hard-stop 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.