Korábbi változatok

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• 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.
  • Other targets of interest being explored by Collaborative participants: assessment/management of 'Long COVID' (e.g., at VA - see this background/guidance article); steroids for COVID-19 meta-systematic review (pursued by COKA)
• 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)

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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.  

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