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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:
Evidence supporting recommendation: | Quality of Evidence: | Relationship between Quality of Evidence - Strength of Recommendation: | ||||||||
Build Evidence Table or reference Evidence Summary | Use GRADE or USPSTF | |||||||||
Condition | Study Design | Author, Year | N | Statistically Significant? | Quality of Study | Magnitude of Benefit | Absolute Risk Reduction | Number Needed to Treat | Comments | |
Response from Brian Alper (lead of EBM on FHIR and COKA):
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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.
Response from Davide Sottara:
Brian, I generally agree with your distinctions on Decision vs Recommendation, and Digital vs Computable.
Yet, I would like to understand how far do you envision a "L3 Recommendation".
A "computable, structured" Recommendation would enable a CDS system to reason over the Recommendation,
and e.g. allow to distinguish the different actions that are recommended, evaluate applicability conditions, and afford for a more
contextual delivery.
Yet, I believe that the current PlanDefinition may be able to express this notion. It's already so polymorphic in nature that
adding 'mood' extensions and profiles for confidence, certainty, and strength may be enough(@Bryn?)
Yet - from a formal knowledge representation & reasoning perspective - there are more aspects to explore.
As 'Recommendations' convey an agent's proposal to close a gap between a current state and a perceived goal state, they can be considered plan fragments,
with "mood(al)", deontic and speech act aspects, and can have elements of belief, confidence and evidence (explanation).
These aspects, which allow to reason with formal Recommendations, require capabilities beyond 'inferences' and 'ECA rules'.
That is, the more we increase the expressivity with additional resources, the more we need to provide tools and guidance on how to correctly
use them - and not only to exchange information.
So - (1) do we need/want a new Resource, or a new Profile, (2) what are the computational implications of the new resource,
(3) can we standardize the pragmatics of reasoning with the resource or leave it to the implementers?
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