- Section A is an overview figure illustrating enhanced information flow around the Evidence/Knowledge/Quality Ecosystem Cycle - i.e., driven by more computable and standards-based evidence and guidance
- Section B is an outline of Collaborative participants joint efforts to better detect and managing evidence/guidance updates that could potentially alter living CDS interventions that participants have deployed
- Section C outlines ecosystem enhancement needs and opportunities, as well as the notes on a potential concept demo toolkit (in the 4th table column) for addressing those needs
- Section D is a diagram illustrating where and how a concept demo toolkit that makes evidence and guidance more computable and standards-based could enhance the Evidence/Knowledge/Quality Ecosystem (and Learning Health System) Cycle
- Section E is an outline with more details about a potential concept demo toolkit for improved evidence/guidance computability
- Section F is notes from a 10/13/20 email about a concept demo among Collaborative participants for enhancing and connecting links in the knowledge ecosystem
A. Evidence Ecosystem Enhancement - Overview Diagram
- UMN/VA teams serve as a core for addressing the goal; they each manage all facets of this supply chain and also consume its results via CDS interventions that support care for their patient populations.
- Cultivate synergies between these 'full cycle' efforts and related Collaborative participant efforts - e.g., NACHC (testing/triage in health centers), ACEP/EvidenceCare COVID-19 Severity Classification/Triage/Disposition tool (see here), Australia Living COVID-19 Guidelines (anticoagulation), U Melbourne COVID-CARE and related efforts, etc.
- Have teams responsible in each of these organizations for evidence surveillance/synthesis, guidance development/updating, and CDS development/updating/deployment collaborate among themselves and with other organizations in the Collaborative on this 'update notification' process and tooling.
- Consider ways to coordinate/advance current efforts: SRDR/COKA, C19HCC Digital Guideline WG, COVID-NMA, COVID-END, AU Living Guidelines, and related efforts collaborate to demonstrate notification system that suggests to living CDS owners/implementers that updates should be considered.
- see below sampling of sources that could be leveraged
- For overview presentation on making evidence computable see: AMDIS Ted Talk EBM on FHIR 2020 Oct 1 PPT
- Document how evidence/guidance changes are detected and addressed in current VA/UMN/other processes
- enhancing these approaches to include a notification function (applicable across approaches) that propagates supply chain updates to all pertinent stakeholders throughout the chain, including those responsible for developing/maintaining CDS interventions.
- Phased enhancement approach
- Document current state: VA/UMN/Australia/others (business-driven requirements - what works, pain points, lessons learned)
- Define/deliver desired future state (Individual/collective)
- quick/easy enhancements to processes/tools/resources used for detecting and managing evidence/guidance updates (e.g., leverage pilot 'web diff tool' to detect changes on target web pages)
- deeper architecture refinements to achieve more computable/standards-based evidence/guidance processing (build on COKA/SRDR explorations)
Excerpt from Knowledge DRAFT Elicitation Tool:
Section F: notes from a 10/13/20 email about a concept demo among Collaborative participants for enhancing and connecting links in the knowledge ecosystem
COVID-19 patient management targets being pursued by ACTS Collaborative participants (anticoagulation and testing/triage) present a promising opportunity for a concept demonstration of making the knowledge supply chain/ecosystem more integrated, efficient and computable. For example:
- The University of Minnesota (UMN) currently has anticoagulation CDS deployed for hospitalized patients with COVID-19 that they seek to make more 'living' and FHIR-enabled. (They're generating evidence that this guidance has favorable mortality implications when followed.)
- Evidence/guidance UMN is using is on this page - in the process of being updated.
- UMN is working with the C19HCC Digital Guidelines WG on leveraging CPG on FHIR for computable guidance development and implementation.
- UMN evidence processing efforts are increasingly supported by the UMN EPC (which is doing this work outside its AHRQ-funded efforts).
- ACTS Collaborative participants are driving initiatives that could support these evidence ecosystem enhancements efforts at UMN in a concept demonstration.
- L*VE/Epistemonikos has a regularly updated search on antithrombotics; can send email when new study/review/guideline is published.
- COKA and SRDR are exploring ways to make evidence more computable and interoperable.
- Sandy Lewis and David Tovey are reaching out to the Evidence/Guidance Community (e.g., GIN, COVID-NMA, COVID-END, others) to help synthesize best practices and tools for supporting evidence/guidance portions of the COVID evidence/knowledge ecosystem. In ad hoc support, David Tovey (former Cochrane Editor in Chief) sent me a Rapid Cochrane review on anticoagulation in COVID-19 patients
- The AU Evidence Task Force has a living guideline on anticoagulation, expressed in the MAGIC app.
- The COVID-END digitizing WG had email explorations into leveraging APIs to exchange evidence information among apps following the WG's meeting last Friday (see thread below).
- Regarding COVID testing/triage,
- ACEP/EvidenceCare has produced an evidence-based severity classification tool and seeks strategies and tools to keep this guidance in sync with evolving evidence.
- NACHC is likewise supporting deployment of testing/triage CDS in health centers across the US, and seeks better mechanisms for keeping this up to date.
- VA also interested in this topic and in ways to better interconnect it's evidence ecosystem (e.g., evidence synthesis program, VA/DOD guidelines) to support living CDS interventions.
- University of Melbourne has a related patient self-monitoring initiative, is likewise interested in evidence ecosystem enhancement efforts, and is planning to leverage this ACTS Participant Window as a focal point for enhancing how AU focused efforts leverage and support similar work by others in the Collaborative.
- Collaborative participants have already begun outlining ways to demonstrate enhanced knowledge ecosystem/supply chain functioning - see sections A-E on this page.
This all suggests that the timing is ripe to define one or more specific demonstrations for better refining and interconnecting the supply chain links outlined above to deliver enhanced care processes and outcomes. Starting in the near term, and building toward more robustness and scaling as the explorations mature.