Korábbi változatok

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• The figure in section A. is an overview of potential enhanced information flow around the Evidence/Quality Ecosystem Cycle - i.e., driven by more computable and standards-based evidence and guidance
• The table in section B. 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 
• The diagram in section C. illustrates where and how a concept demo toolkit that makes evidence and guidance more computable and standards-based could enhance the Evidence/Quality Ecosystem (and Learning Health System) Cycle
• The email excerpt in section D. provides considerations related to using computable/standards-based evidence descriptions to make developing and updating computable clinical recommendations more efficient and effective. 

A. Evidence Ecosystem Enhancement - Overview Diagram (Enhanced Ecosystem Concept Demo Opportunity 8.26.20.pptx)

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C. Overview Diagram for Proof of Concept Demo Toolkit (computable evidence slide.pptx)

D.  Excerpts from 9/4/20 email exchange about using computable/standards-based evidence descriptions to make developing and updating computable, evidence-based clinical recommendations more efficient/effective.

Adapted version of note from Jerry Osheroff:

Below is a small excerpt from the HL7 CPG on FHIR Draft Computable Guideline L2 Template (Recommendation tab) being used by the C19HCC Digital Guidelines WG. The question the Learning Community is exploring is whether/how the trajectory of SRDR/COKA efforts to provide computable, standards-based input and out from SRDR could at some point and in some way lead to auto-populating/updating this type of information in some future version of this template:

Response from Brian Alper (lead of EBM on FHIR and COKA):

The format for human expression can look very different from the format for computable expression.   But if we can agree to a standard for computable expression we can support a near-infinite set of patterns of human expression.

Some thoughts below to inform a computable expression of a “Recommendation” and I end with a link to a first draft for it.

As a recap to some of the concepts to clarify recommendation vs. CDS artifact:

One of the challenges in defining L2/L3 and recommendation/CDS may be recognized by 2 different factors (Recommendation/Decision Rule, Digital/Computable):

• A Recommendation can be an expression of what should be done – Flu vaccine is recommended for people who have not received a flu vaccine this season.
• A Decision Rule can be an expression of the logic to be applied – If a person does not have a record of receiving a flu vaccine this season, then offer/provide a flu vaccine.
• The Recommendation and Decision Rule can be applied in clinical practice completely using Print expressions.
• The Recommendation and Decision Rule can be applied in clinical practice completely using Digital expressions.   This sentence is shared with you now in a Digital expression in this email but is not a Computable expression of the concepts.
• The Recommendation can be converted to a Computable expression – an L3 artifact that provides “Flu vaccine” as a codeable concept, “people who have not received a flu vaccine this season” as a codeable concept, and “is recommended for”
  as a codeable concept.   This L3 artifact can be considered a CDS artifact but it is not yet sufficient for immediate functional use in a specific CDS system.
• The Decision Rule can be converted to a Computable expression – in addition to the codeable concepts in the Recommendation, additional codeable concepts to express include “have a record of”, “offer/provide”, and the “if…then” logic.  This L3 artifact would also be considered a CDS artifact.

The original goal of the EBMonFHIR project was to provide for computable expressions of evidence and recommendations.   With the CDC ACQ Informatics Value Stream effort focused on converting guidelines to CDS artifacts, a companion CPGonFHIR project developed.   It appears the CPGonFHIR expresses Decision Rules in computable form and the PlanDefinition Resource expresses the action(s) in computable form.   We have been discussing shared use of Group and EvidenceVariable Resources that can express parts of the “when recommended” concepts in computable form. However, there is not yet a specific resource for the Recommendation in computable form which can be used prior to creating the Decision Rule derived from that Recommendation.

Working off of what we have learned from the evidence-related Resources and the PlanDefinition Resource, I have created a first draft of a Recommendation Resource to bridge this gap.