ACTS COVID-19 Collaborative Learning Community
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INITIAL DRAFT FOR DISCUSSION/UNVETTED

Background

The ACTS Roadmap - and this ACTS COVID-19 Guidance to Action Collaborative and Learning Community - focus on improving the cycle whereby evidence gets translated into knowledge and tools that support care delivery/improvement actions which generates data about results, which feeds into evidence, and so on. This page presents various diagram that have been developed to depict this cycle, and the elements that support and drive it. These diagrams are being integrated and refined by Collaborative participants to clarify how various efforts focused on the cycle can come together more efficiently and effectively to achieve shared goals and drive progress toward executing the ACTS Roadmap.

List of Evidence/Knowledge/Quality Ecosystem Diagrams

  1. ACTS LHS cycle

  2. More detailed ACTS current/future state LHS/Knowledge Ecosystem Cycle

  3. Magic evidence ecosystem diagram visualizing key AHRQ actors and offerings, standards, methods, platform, other actors on top of 'evidence ecosystem diagram'

  4. Quality Ecosystem - FHIR Standards (Maria Michaels version)

  5. Brian Alper/COKA FHIR Diagrams

  6. Mary Butler/UMN-EPC Ecosystem Diagram

  7. Theoretical Enhanced Evidence/Quality Ecosystem - potential UMN/C19HCC/EPC example

1. ACTS Learning Health System (LHS) Cycle


2.More detailed ACTS current/future state LHS/Knowledge Ecosystem Cycle

3. The diagram below is part of a slide deck prepared for ACTS by Per Olav Vandvik and Linn Brandt from the MAGIC Evidence Ecosystem Foundation. [slide 2 in the MAGIC deck has an editable version of the diagram copied below.] Learning Community participants are adapting this diagram to reflect components of the evidence/knowledge/guidance ecosystem they are addressing, e.g.,  with living CDS interventions for specific COVID-19 targets (and ultimately many other topics beyond).

  Full deck is here: from MAGIC - Solutions Evidence Ecosystem for ACTS October 28 2019 (2).pptx


4. Quality Ecosystem - FHIR Standards (Maria Michaels version)




5. Brian Alper/COKA FHIR Diagrams

                                                   





Alper/COKA also working graphic "Computerized Organization to Realize Ecosystem": "The slices of the circle are DATA to EVIDENCE to GUIDANCE to ACTION. The layers from the outer ring to the core show each slice from GENERAL to SPECIFIC to COMPUTABLE to EXECUTABLE. The closer to executable, the closer to the CORE and this matches the interoperability reached when reaching the CORE. Overall this is the Computerized Organization to Realize the Ecosystem (CORE). "



Full Deck from Alper/COKA is here - above is slide 7 from this deck.

6. Mary Butler/UMN-EPC Ecosystem Diagram  


 

JO Notes on this EPC diagram - are there opportunities to:

  • tie 'topic nomination' more closely to care transformation initiatives (e.g., as in ACTS COVID Guidance to Action Collaborative)? (currently there can be open nominations, but typically nominations only proceed if there is an 'adoption partner'; growing attention to feeding LHS efforts)
  • leverage standards more fully to improve FAIRness of information flowing into reviews and applying reviews more seamlessly to guidance/CDS/eCQM development? e.g., as outlined in table at top of this page. (SRDR/EPCs and others working on this)
  • tighten connections/collaborations between 'NextGen' offerings (more computable/concise/user-friendly/interactive evidence summaries) and those who can benefit from integrating that information into guidance and CDS offerings downstream? (there's important application nuance in the reports)
  • otherwise more tightly integrate the EPC/SRDR products and processes with broader efforts (e.g., ACTS COVID Guidance to Action Collaborative and other related efforts) in mutually beneficial ways?   



7. Enhanced Evidence/Quality Ecosystem -

       A. Potential NACHC/C19HCC/EPC ambulatory triage CDS example (Enhanced Ecosystem Concept Demo Opportunity 8.26.20.pptx)

[DOC search hyperlink]






B. Details for SRDR+/COKA-enabled Ecosystem Enhancements focused on Collaborative Participant Key Targets (anticoagulation, triage and testing in ED/Ambulatory settings)


Ecosystem StepHigh Priority Enhancement Needs/Opportunities1Potential SRDR+/COKA-enabled EnhancementsUNVETTED Straw-horse Fantasy (for Target Foci)Other Notes/Comments

Process evidence

  • Quickly identify/select evidence pertinent to topic (e.g., PICO-based inclusion criteria for a study)
  • Data extraction (e.g., results: numerators/ denominators, aggregate measures) from studies is labor intensive and error prone
  • computable expressions for PICO criteria (now working on outcome definition component); if evidence has standardized PICO tags, it will be faster to identify/select evidence.
  • computable expressions for results (statistics); if evidence has standardized, structured results reported it will be faster and more accurate to extract/upload data into review authoring tool
  • A team (e.g., at NLM?) uses a pilot COKA-enabled tool to identify and apply COKA tags to all studies (previous and emerging) related to COVID-19 and anticoagulation. 
  • EPCs (e.g., UMN for anticoagulation, ? others for other targets) use a pilot COKA-enhanced version of SRDR+ to produce living systematic reviews.
  • Systematic reviewers are proactively notified when there are new studies so that updates to the systematic reviews can be considered. 
  • Cochrane registry has PICO tags (as do other systems), but since these aren't standardized, info can be missed. (searching Cochrane on 'diaper rash' may not find evidence tagged as 'nappy rash' - standard disease codes would address this)
  • SRDR has FHIR-based expression of outcome. COKA has outcome definition viewer coming soon. With SRDR-defined outcome tags and Cochrane-defined outcome tags mapped to the same standard, a search in one system can find evidence in the other system.  
Produce Living Guidance
  • Need to quickly/easily determine (e.g., within/ across systematic reviews) judgements about quality of evidence and certainty of findings. This is problematic because different systematic reviews express these in different ways, making this critical information difficult to assess within and across reviews.
  • computable expression for evidence certainty (certainty assessments and reasons for these assessments); 
  • Guideline developers (e.g,. SCCM/ASH for anticoag, ACEP for ED triage, ? CDC for ambulatory triage) use a pilot COKA-enabled tool to produce living, computable guidance (e.g., building on the type of functionality AU Living Guidelines has implemented with MAGICapp - see anticoagulation example)
  • Guideline developers are proactively notified when there's an update to systematic reviews so that updates to the guidance can be considered. 

Develop CDS/eCQMs

  • C19HCC Agile Knowledge Engineering Teams use the pilot COKA-enabled tool that produces living, computable guidance to drive updating of living CDS interventions and related eCQMs
  • Teams are proactively notified when there's an update to the guidance so that updates to the CDS/eCQMs can be considered. 

Implement CDS/eCQMs



Analyze/Use Care Results 

(report, produce evidence)





Cross-cutting Issues



1By those doing the work - e.g., EPCs, VA/UMN/Health Centers, Agile KE teams, NACHC/ACEP/EvidenceCare, many others


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