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Identify (Search/Screen) Primary Studies (See this CoP page)

Synthesize Evidence (including assessing quality) (See this CoP page)

Current 

Approach

  • manual key word literature searches, SME awareness of studies (ACEP/EC)
  • SMEs review content, track in spreadsheet (ACEP/EC)


Pearls/Tips Learned/Tools
Desired Approach
  • Curated article, review every few weeks based on keywords and filters, with direct links to PDFs to speed content access (ACEP/EC).

  • 3rd party reviews the studies and provides summary of key data in easily digestible format (ACEP/EC)

  • Standards for sharing  (ACEP/EC)
Needs to Achieve Desired Approach

Check all that apply

__Better source/input materials [Details: ]

__Common format/terminologies for managing/sharing data [Details: ]

__Other [Details:]


COVID-END Needs:

Use an online administrative interface for processing records (rather than Excel) and a more elegant front-end solution for displaying the inventory

_x_Better source/input materials [Details: ] Harvest from all high-yield, high-quality sources

_x_Common format/terminologies for managing/sharing data [Details: ] COVID-END taxonomy

_x_Consistency of outcomes [Details:]

_x_Engagement with primary researchers and upstream stakeholders [Details: When gaps in the best-available evidence related to the pandemic response are identified (e.g., a taxonomy category in the inventory has no high-quality evidence synthesis available) engaging researchers and research funders may help to set priorities for research needed to fill gaps)]

_x_Engagement with decision makers and other downstream stakeholders [Details:] Regulator interactions with government officials in many Canadian provinces and in many other countries

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Check all that apply

__Better source/input materials [Details: ]

__Common format/terminologies for managing/sharing data [Details: ]

__Other [Details:]

Support We Can Provide Other Participants

From COVID-END

Identify published systematic and rapid reviews from trusted sources (including VA ESP Covid-19 Evidence Reviews and Cochrane) and present these in the COVID-END inventoryAdd decision-relevant information to each document included in the inventory in order to support easier assessments of relevance, including:

  • flagging review search dates (to support assessments of how up-to-date the evidence is);

appraising and reporting quality using AMSTAR 1 tool (to provide information about the quality of each review);

  • identifying which reviews are living and which have a GRADE evidence profile; and
  • creating declarative titles for ease of understanding and applicability for policymaker end user.

The COVID-END Inventory aims to identify best current evidence in the four taxonomies, and to identify those reviews that are living, up to date, high quality and where there is a GRADE evidence profile. Inventory also provides link to the underlying reviews in addition to outputs described above.

COVID-END ... aims also to commission living systematic reviews to address high priority areas that may not have been sufficiently addressed by evidence synthesis researchers.

Further outputs include resources for researchers and guidelines developers that are proposing to conduct a systematic review or develop clinical practice guidelines – aimed at reducing inadvertent and inappropriate duplication of effort and increasing the quality of reviews and guidelines produced

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Produce Guidance (See this CoP page)

Make Guidance Computable (See this CoP page)

Current 

Approach

  • Using the Agile Approach to CPG Development (inclusive of Integrated Process) to concurrently Produce Guidance and Make Guidance Computable in Agile CPG Team (C19 DGWG)
Pearls/Tips Learned/Tools
  • getting variables coded/mapped is key but time consuming (UMN)

Approach Used by C19 DGWG

  • Using CPG-on-FHIR standard for representing/ expressing the full intent of the Guidance in computer-interpretable artifacts (part of HL7 CPG-IG)
  • Using the Agile Approach to CPG Development (inclusive of Integrated Process) to concurrently Produce Guidance and Make Guidance Computable (part of HL7 CPG-IG)
  • Use Agile Knowledge Engineering methods, principles, and tools
    • Cross-functional Integrated team (Agile CPG Team)
    • Leverage composite nature of CPGs (e.g. can develop logic for inferences on patient information- CPG_CaseFeatures) to build incrementally and iteratively with rapid feedback
    • Pull knowledge engineers into Content design/reviews; pull domain SMEs into knowledge representation design/reviews
  • Leverage CPG-on-FHIR as a faithful expression of Guidance and its ability to create computationally derived CDS and Cognitive Support, patient-specific, practice-level digital Quality Measures/Metrics, eCaseReports, etc. to create computable artifacts used downstream in the Learning Health System and to provide closed-loop feedback/feedforward.
  • Leverage established tools and capabilities (e.g. BPM+ process and tooling, Clinical Ontology) to author computable Guidance and Open Source tooling to translated into HL7 CPG-on-FHIR to leverage derivative and native compute

Additional Pearls from C19DGWG

  • Engage consumers/ users early and often
  • Engage downstream vendors (e.g Terminology vendor USED in the EHRs) early
  • Just because everyone everyone is using the same terminology systems doesn't mean they're agreeing how to use the actual terms- this needs to be considered and addressed to make ecosystem/supply chain work properly (feedforward from Evidence, but also feedback of data semantics back into evidence)
  • Learn from related communities of practice (e.g. Agile Software Engineering)
Desired Approach
  • Harmonize latest evidence from multiple sources and serve/push the guidance to partnered HCCNs (NACHC)
  • Seamless collaboration of clinical stakeholders to determine best practice approach in a constantly evolving environment; More asynchronous work processes to optimize efficiency (ACEP/EC)

From C19DGWG

  • Build computable artifacts/assets on Real-World data to enable better design/ specification and Test-driven Development (Agile)
  • Leverage mature Knowledge Base to implement Knowledge Architecture (e.g. CPG profiles) and design, develop, test, maintain, and reuse artifacts/ assets
  • Concurrent Validation and Development using above

Others

  • better mapping approaches/collaboration with terminology vendors to speed mapping (UMN)
  • Pull together multiple fit-for-purpose standards addressing the whole stack: BPM+, SNOMED, FHIR, ANF (VA)
  • Interoperable format leveraging CPG-on-FHIR (working with C19 digital guideline WG on this) (UMN)


Needs to Achieve Desired Approach

Check all that apply

__Better source/input materials [Details: ]

__Common format/terminologies for managing/sharing data [Details: ]

__Other [Details:]

  • Better collaboration structure to bring parties together consistently (ACEP/EC)

Check all that apply

__Better source/input materials [Details: ]

__Common format/terminologies for managing/sharing data [Details: ]

  • Collectively Improve data dictionary for prospective use case: collect patient-level COVID-19 data (NACHC)

__Other [Details:]

Support We Can Provide Other Participants
  • Engagement with ACEP’s group of clinical expert (ACEP/EC)
  • Data dictionary development (NACHC)

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