The ACTS COVID-19 Guidance-to-Action Collaborative is bringing together organizations and initiatives with the goal of enhancing collaborations to:

• Develop, refine, and implement tools and standards that seed the digital knowledge platforms, knowledge ecosystem, reference architecture, and public private partnerships called for in the ACTS Roadmap

• Help stakeholders better address specific COVID-19 care support needs with living CDS interventions in the short term, and many other urgent care/public health improvement targets in the longer term.

This page provides an overview of what everyone in the collaborative is doing. The four child pages are where you can do work on actually coordinating the various components of the work including the knowledge supply chain, intervention development, intervention implementation, and closing the loop.

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ACTS C-19 Collaborative’s Coordination Effort Overview Diagram [DRAFT]

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Collaboration Hub Framework

The table/diagram skeleton below is a more detailed framework for enhancing knowledge/evidence/quality ecosystem collaboration than the diagram above. After framework vetting and refinement by the Collaborative, participants will help populate tables/diagrams based upon it as a means to coordinate and enhance efforts within this ecosystem and the results it produces. 

The initial core focus will be the COVID-19 topics outlined below and described in more detail following the framework. However, broader opportunities to strengthen the ecosystem in ways that drive progress toward implementing the ACTS Roadmap are also of interest. Diagrams on the next several pages are earlier efforts at presenting information of the sort addressed by this framework; this previous work will be incorporated into subsequent efforts to build out and leverage the skeleton below.

Questions/Needs Addressed in Collaborative Participant Efforts

• COVID-19 Patient Assessment, severity classification, decision making/recs (pilot focus is on demonstrating DKP and related architecture and collaborations to address these needs, since evidence base is early-stage)
  
  • Symptom eval/triage/test & mgt recs
    • At home - remote triage of patients with possible COVID-19 symptoms
    • ED - Severity assessment and optimal disposition
    • At home - monitoring /managing COVID patients: assess disease course, modify care plan as needed (e.g, send to hospital, follow-up after discharge)
  • Risk assessment/mgt support
    • Inpatient: patient’s risk of deterioration over the next 12-24 hours
    • ICU: patient’s risk of deterioration over the next 4-12 hours
  • Anticoagulation
    • Inpatient/ICU: anticoagulation this patient should receive
• Other Needs addressed in clinical implementation pilots (where evidence-base is strong; pilot demonstrates that DKP technology/architecture/collaborations currently focused globally on COVID-19 can applied to other targets) 
  • Diabetes management
  • Preventive care (prostate, breast, colon cancer screening)
  • Statin use

Activity/Status Summary by Organization implementing the living CDS

Activity/Status Summary by target

Activity/Status Summary by Supply Chain Component

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EARLIER NOTES: To Be Filtered into Framework Outlined Above

I. Exploring Components of 'Supply Chain' for Addressing Clinical Questions/Needs in an LHS Cycle (working backwards from supporting patients and care teams)

• Address question/need with interventions that optimize workflow/information flow and enable performance results tracking and use
  • Apply user-centered design/human factors engineering approaches to design, create, test, implement, and enhance interventions; distill, disseminate, apply and continually enhance tools and processes for doing this
    • workflow modeling (current/future state) 
      • e.g., BPM+
    • Identify specific CDS intervention types and process/outcome measures
      • e.g., CDS: care management summaries/dashboards, severity/risk algorithms, order sets, documentation templates, etc.; Measures: CDS intervention use, clinical intervention use, morbidity/mortality results
    • standards-based intervention design
      • e.g., FHIR CPG Implementation Guide
  • Provide marketplace for implementers to find, evaluate and acquire the interventions
    • e.g., CDS Connect; clickable concept demo/requirements analysis from MAGIC team
  • Integrate interventions into pertinent tools and information systems
    • e.g., SMART on FHIR, CDS Hooks, NLM Value Set Authority Center (VSAC), US Health Information Knowledgebase (USHIK)
  • Provide change management support and training for those affected by the interventions
    • e.g., guidance from AHRQ's Patient Safety Network, collaborations supported by ACCME
  • Provide mechanism for gathering and analyzing performance results, and applying them to continuous improvement locally and beyond
    • e.g., collaborations with Medisolv, implementers
• Keep CDS interventions 'living' by continuously updating with latest evidence-based recommendations (DKP provides ready access to all these knowledge assets, and increasingly tools/standards for creating them)
  • Maintain guidance summaries on needs 
    • E.g., from Penn CEP on ACTS COVID website, guideline clearinghouses such as ECRI Guideline Trust, pertinent sources COVID-END list
  • Maintain living recommendations on needs
    • COVID
      • Assessment/triage, Risk/Severity prediction
        • e.g., NIH/CDC, ACEP, Australia
      •  Anticoagulation
        • E.g., NIH/CDC, ASH, Australia, others
    • Other
      • Diabetes
        • e.g., ADA, others
      • Preventive care
        • USPSTF
      • Statins
        • e.g., ACC/AHA
      • Integrating behavioral health and primary care
        • e.g., AHRQ Integration Academy
  • Maintain living systematic reviews on needs and support their application to living recommendations (see table below); DKP includes or leverages tools to:
    • Aggregate/find/access systematic reviews on topic
      • e.g., SRDR Plus, and pertinent sources COVID-END list for COVID topics
    • Create systematic review on topic
      • Monitor, access studies and reviews on topic 
        • e.g., leveraging infrastructure/processes in the AHRQ Effective Healthcare/EPC Program; COVID-END list and COKA for COVID topics; EBM on FHIR for making study/review components computable
      • Evaluate/process data from studies to create and update review; platforms for creating/maintaining systematic reviews
        • e.g., ClinicalTrials.gov; SRDR Plus; COVID-19 Knowledge Accelerator (COKA); DistillerSR
  • Provide feedback about care and results at the patient and population levels to drive the LHS cycle
    • E.g., leveraging AHRQ data resources such as HCUP, MEPS and others; CMS/ONC eCQI Resource Center 

II. Additional notes about initiatives focused on COVID-19 knowledge supply-demand chain/cycle

III. Explorations/efforts above as a seed for the AHRQ Digital Knowledge Platform (DKP) and Knowledge Ecosystem

• Functionality to accomplish steps outlined will be explored, e.g.,  via tools and approaches that seed the AHRQ Digital Knowledge Platform and related component of the Knowledge Ecosystem (KE) called for in the ACTS Roadmap.
• These components include include integration engines, advanced search engine, UI / Dashboard display visualization software, API software, etc.) to enable users (e.g. developers and consumers of resources such as systematic reviews, clinical recommendations/guidance/guidelines, CDS interventions (including L4 localizations, etc.) to produce, access and maintain key resources from AHRQ and others - e.g., as outlined above.
• In addition to the technology components of the AHRQ DKP and broader KE, the explorations will also seed development and evaluation of other key components of these outlined in the ACTS Roadmap including portions of the Reference Architecture and the Public Private Partnership