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changes.mady.by.user Jerry Osheroff

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changes.mady.by.user Jerry Osheroff

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C. Unified diagram for SRDR/COKA-enabled ecosystem enhancements focused on anticoagulation, ED triage, ambulatory triage, (and testing)


Notes/
Ecosystem Step
Needs by those doing this workOutput produced
High Priority Enhancement Needs/Opportunities1Potential SRDR+/COKA-enabled EnhancementsDiagraming a Compelling 'Future State'Other Notes/Comments

Process evidence

  • Quickly identify/select evidence pertinent to topic (
SRDR/COKA-enabled
  • e.g., PICO-based inclusion criteria for a study)
  • Data extraction (e.g., results: numerators/ denominators, aggregate measures) from studies is labor intensive and error prone
  • computable expressions for PICO criteria (now working on outcome definition component); if evidence has standardized PICO tags, it will be faster to identify/select evidence.
  • computable expressions for results (statistics); if evidence has standardized, structured results reported it will be faster and more accurate to extract/upload data into review authoring tool
  • SRDR has FHIR-based expression of outcome. COKA has outcome definition viewer coming soon. With SRDR-defined outcome tags and Cochrane-defined outcome tags mapped to the same standard, a search in one system can find evidence in the other system.  
  • Cochrane registry has PICO tags (as do other systems), but since these aren't standardized, info can be missed. (searching Cochrane on 'diaper rash' may not find evidence tagged as 'nappy rash' - standard disease codes would address this)
Produce Living Guidance
  • Need to quickly/easily determine (e.g., within/ across systematic reviews) judgements about quality of evidence and certainty of findings. This is problematic because different systematic reviews express these in different ways, making this critical information difficult to assess within and across reviews.
  • computable expression for evidence certainty (certainty assessments and reasons for these assessments); 


Develop CDS/eCQMs



Implement CDS/eCQMs



Analyze/Use Care Results 

(report, produce evidence)





Cross-cutting Issues



1By those doing the work - e.g., EPCs, VA/UMN/Health Centers, Agile KE teams, NACHC/ACEP/EvidenceCare, many others