Korábbi változatok

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D. More Details on Knowledge Supply Chain Enhancements 

D.1: UNVETTED DRAFT Notes on a Near-term Approach for Propagating Down the Knowledge Supply Chain Notifications about Impactful Updates  

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Goal:

Illustrate how

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for a sample target (anticoagulation and/or COVID-19 testing/triage)

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• we can signal to care teams (through 'living' CDS interventions) when a change in the evidence-review-guidance supply chain content for this target indicates a change in recommended care. Or this change indicates that the strength of evidence/guidance supporting a recommendation has changed. (The latter is important so this new information can be factored into patient-clinician shared decision making accordingly.)

Approach:

• VA and UMN (for the most part) manage all facets of this supply chain and also consume its results via CDS interventions that support care for your respective patient populations. This suggests that these 2 organizations could each be logical homes/centerpieces for efforts focused on demonstrating the tighter link outlined above between new guidance/evidence and updating the corresponding CDS interventions (e.g., focused on anticoagulation and testing/triage).

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• This would mean

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• having the teams that are 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.
• We could explore ways to leverage related efforts for content and approaches to apply in the notification system. For example, consider mutually beneficial ways to apply SRDR/COKA, C19HCC Digital Guideline WG, COVID-NMA, COVID-END, AU Living Guidelines, and related efforts to produce a a triggering system to that  suggests to living CDS owners/implementers that updates should be considered.

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• For example, below is a sampling of external evidence/guidance sources that could potentially be leveraged to enhance current VA/UMN processes in developing the 'update notification' system. We could start by documenting how evidence/guidance changes are detected and addressed in current VA/UMN processes, and exploring enhancing these approaches to include a scalable notification function that propagates supply chain updates to all pertinent stakeholders throughout the chain, including those responsible for developing/maintaining CDS interventions.  

• We could begin by synthesizing a largely manual update detection and notification mechanism that runs throughout the supply chain, then semi-automated approaches (e.g., that detect changes on target web pages), and ultimately fully automated approaches that leverage computable, standards-based, interoperable information throughout the supply chain.
• Important foundational work for this has been laid in SRDR/COKA collaborations, and we should explore how to fully leverage and build on this in developing an 'update notification' approach. Especially since SRDR is an important component of AHRQ's current digital knowledge platform.

Sampling of External Sources to Check for Updated Evidence/Guidance on Targets

• COVID-NMA (search for heparin)
• VA COVID Reviews (search for triage, testing, anticoagulation)
• COVID END Best Evidence Synthesis (see testing/triage here, and others/anticoagulants here)
• NIH Guideline on Antithrombotic therapy
• CDC Phone Triage Guidance
• ACEP/EvidenceCare computable guidance on ED triage (based on this guide)
• AU Living Guidelines - see 'definition of disease severity' and 'VTE' 
• [other resources listed on Collaborative's evidence/guidance processing CoP page]

D.2: Notes on a More Comprehensive Proof of Concept Software Toolset 

The 4 proof of concept tools and related repository outlined below can be placed on an open source developmental website for public dissemination. Content development for these tools will be driven by Collaborative participant current efforts, e.g., focused on COVID-19 testing/triage in ambulatory and ED settings and anticoagulation in inpatient settings.

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