Korábbi változatok

What to know/do Overview

('nouns and verbs' - what goes in rows below in each table are the 'lists' associated with this the bullets in this row)

• L*VE/Epistemonikos
• Cochrane COVID-19 study register
• NIPH COVID-19 Living Evidence Map
• MedRxiv
• ClinicalTrials.gov/COVID-19
• New pubmed interface
• DoctorEvidence CORD-19 Dataset Search
• EBSCO COVID-19 Information Portal
• University of Michigan COVID-19 Best Evidence Front Door 

• NEWS2 predicts severity/mortality at admission
• Annals IM, hospitalized patient trajectories
• Sensitivity, Specificity Predictive Values of Tests for COVID-19 in ED
• PREDI-CO Risk assessment tool

• For steroids systematic meta-review, 8 sources have been identified these are (MEDLINE, CORD-19, L-OVE/Episteminokos, NIH iSearch COVID-19, EuropePMC, WHO COVID-19 Database, EMBASE + Prospero) 

• Librarian Reserve Corps
  • COVID-Evidence Project - building a database to gather all the evidence around a drug (University of Basil - currently focused on hydroxychloroquine, but model could be adaptable to other targets)
  • Identification of sources to identify primary studies - validation study of specialized COVID-19 databases (systematic reviewers are going to different sources - this effort is to identify best practices)
  • Advocate for librarian representation in searches and reviews - leverage skillsets/best practices in this work
    [SLMC]: close gaps between needs that clinicians are seeing on the front line and topics covered in reviews guidelines
• COKA Evidence/ Tools WG [Project Google Drive](work in process)

• Framework slides: Applying Standards to the Evidence Domain (from the COKA Evidence Ecosystem Liaison WG)

• [CPG on FHIR and BPM+ IGs do this separately - need to be combined and simplified (e.g., with helpful graphics); e.g., leverage L1-L4]
• [Approach section from CPG on FHIR IG might be helpful in framing scope]

[Evidence synthesis teams would like to have something that summarizes for a COVID resource database, where are they pulling information from, what are their inclusion/exclusion criteria, why you might use one source vs. another]

[CPG on FHIR team would like to incorporate insight we generate here - including BPM+ synergies, back into that resource. The 'Integrated Process' about how to develop narrative and computable guidelines in parallel - will be published in about a month.]

Robert Lario - co-chairs OMG BPM+ activities. 3 languages - process modeling (BPMN), decision modeling (DMN), case/event (CMMN) modeling. VA using these to express clinical practice guidelines - sometimes just instructive, other times executable. All have execution models. BPM+ has its own ecosystem. Gaps and hard to do some things with BPM +. Started working on 3 other modeling languages. Situational data - how do you represent structure of data, etc. Provenance who owns/controls and access. and Pedigree: what produces what. Knowledge Package: Many languages/constructs used in a guideline (sequencing). How do you bundle these up into a CPG. How do you surface models, discuss dependencies. Focusing on how do you express knowledge in a clear and unambiguous way, and how to you create artifacts? CPG on FHIR speaks more to methodology - complements BPM+ which doesn't get into deep detail on this. Also not looking at curation and management of models.

Blackford: DGWG ran through effort to implement guidance based on CPG on FHIR. Would like to use a resource like this table to know which tools to use to make guidance computable in different circumstances. How do you implement this at scale.

Address dissemination and marketplaces. (HL7 Marketplaces spec)

• See output repositories under Produce Guidance

• CDS Connect Repository

• CPG on FHIR (working to coordinate with BPM+, and don't yet incorporate value sets); value could be enhanced by better connection through connecting what's in CPG on FHIR to links before and after it in the ecosystem cycle. 
• BPM+
• Logica-led Care Management Implementation Guide [standards and guidance] to cultivate synergies between CPG on FHIR and BPM+ [in development - e.g., see info on Care Management Track at 2020-09 Connectathon]) 
• CDS Hooks;
• SMART on FHIR
• COVID-19 Interoperability Alliance Value Sets
• Logica COVID-19 FHIR Profile Library IG
• [under development] MCBK Standards WG Metadata work

• CDS Connect Authoring Tool

From C19HCC Digital Guideline WG:

• 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
• tips:
  • Use established standards and work with standards community (to understand and evolve as needed)
  • 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)