INITIAL DRAFT FOR DISCUSSION/UNVETTED

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.

ACTS COVID-19 Collaborative Learning Community > Approach, Participants, Targets, Status Overview > ACTS COVID-19 Guidance-to-Action Collaborative Collaboration Hub.jpg

--------------------------------------------------------------------------

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

ACTS COVID-19 Collaborative Learning Community > Approach, Participants, Targets, Status Overview > image2020-7-22_17-13-23.png

--------------------------------------------------------------------------

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. Portions of skeleton below are populated in the respective Community of Practice pages.

Produce/Synthesize Evidence and Guidance

Create CDS/eCQMs

Implement CDS and eCQMs

Analyze/Use Results ('Close the Loop')

Topics (e.g., core foci for Collaborative: Severity/Risk/Triage, Monitoring, Anticoagulation; others)

Actors (e.g., participants in ACTS COVID Guidance to Action Collaborative, many other orgs/initiatives; also roles - e.g., CDO leader, care delivery participant, quality person etc. [label discussion threads by these roles]

Standards for Outputs (e.g., from HL7/FHIR, BPM+)

Sources for Inputs/Outputs (e.g., SRDR, L*VE/Epistemonikos, CDS Connect)

Tools/Methods/Platforms (Systematic review creation tools, tools from COKA WG, CDS Connect Authoring Tool)

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

Org	Targets addressed	planning/implementation status	Notes (challenges, pearls, needs, etc.)
UMN	anticoagulation	CDS intervention under development with C19HCC team Preliminary development, implemented, and evaluated (details)
VA	Remote triage Patient Manager ICU Severity Assessment		See goals/plan draft in on implementation page; see sample draft charter here
Health Centers	Remote triage Home management
Others?

Activity/Status Summary by target

CDS/ Target	Sites Addressing	Evidence/guidance/Measure highlights	Intervention development highlights	Cross-fertilization Needs (e.g., tools, strategies)
Remote triage	•Health centers (details) •VA (details)	clinical prediction tool preprint	University of Manchester developing the intervention (details?)
Home management	•Health centers (details)
Anticoagulation	UMN (14 hospitals)
ED severity/ disposition	TBD by ACEP/ EvidenceCare		Content has been finalized and is in the approval process at ACEP. Shareable assets are being developed.
Inpt. Severity Assessment	VA (ICU)
Others?

Activity/Status Summary by Supply Chain Component

Supply Chain Component	Overview of efforts to optimize this component
Gather evidence, produce living systematic reviews	Explorations underway with AHRQ EPCs/SRDR, COKA, COVID-END and others about strengthening this portion of the supply chain
Produce living guidance and measures	•Explorations with ASH, ACCM, ACEP, C19HCC about collaboration to enhance flow from row above through this row to following row. •Explorations with AU Living Guidelines team and other Collaborative participants about leveraging their living guidelines in living CDS development efforts by Collaborative participants and leveraging efforts in row above to support their living guideline efforts
Incorporate/update guidance/ measures in CDS interventions	•Collaborations with C19HCC Digital Guideline WG to foster synergies between the CPG IG-based Agile Knowledge Engineering approach they’re applying in the anticoagulation and ED severity work and efforts by other Collaborative participants.
Deploy CDS interventions	•Collaborations with C19HCC Digital Guideline WG to foster synergies between the CPG IG-based Agile Knowledge Engineering approach they’re applying in the anticoagulation and ED severity work and efforts by other Collaborative participants.
Measure results and use for continuous improvement	•Collaborations with C19HCC Digital Guideline WG to foster synergies between the CPG IG-based Agile Knowledge Engineering approach they’re applying in the anticoagulation and ED severity work and efforts by other Collaborative participants.

--------------------------------------------------------------------------

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

Supply Chain Component	Initiatives
Identify / Prioritize Knowledge, Support Needs	See 'Taxonomy of Decisions' from COVID-END See 'sources of titles questions' in COVID-END list Academy Health Report: Health Systems’ Priority Research Questions on COVID-19
Outcomes Data/Research Studies and Results	COVID-19 Knowledge Accelerator (COKA) See 'studies' in COVID-END list University of Washington Daily COVID-19 Literature Situation Report OHDSI COVID study-athon (Background:Breakout sessions) international community, large-scale health data analytics NIH BRICS (Biomedical Research Informatics Computing System; tool to collect, validate, harmonize, analyze research datasets) NIH Common Data Element Resource Portal NIH webinar on Sharing, Discovering, and Citing COVID-19 Data and Code in Generalist Repositories L*VE/Epistemonikos project
Evidence/Guidance Syntheses	Evidence-based Practice Centers Penn Center for Evidence-based Practice See 'systematic reviews' and 'rapid reviews' in COVID-END list VA Evidence Synthesis Program - COVID-19 Reviews L*VE/Epistemonikos project (.RIS file with some citations relevant to Collaborative targets retrieved by David Tovey) COVID-NMA project
Guidance/Recommendation Development - Narrative	ACTS COVID pilot See Recommendation (Guidance) sources in COVID-END list
Guidance Implementation - CDS Interventions	CDC/Adapting Clinical Guidance for the Digital Age spin-off efforts C19HCC ED-InPt-ICU Clinical Practice Guideline Team: kickoff-meeting slides, workgroup signup sheet Ambulatory Team At Home Team Mobilizing Computable Biomedical Knowledge (MCBK) Vocabulary/Modeling COVID-19 Interoperability information from ONC Logica-led COVID FHIR Profile Implementation Guide, and related Clinical Architecture/COVID-19 Interoperability Alliance COVID-19 Interoperability Asset Google Group (FHIR Profiles, v2/3, CDA etc discussion) LOINC SARS Coronavirus 2 Codes SNOMED - Jan 20 International Release
Overarching/Learning Health System	AHRQ evidence-based Care Transformation Support (ACTS) Initiative MAGIC - e.g., see these slides COVID-END (COVID-19 Evidence Network to support Decision-making) C-19 healthcare coalition, and this document Global Digital Health Network see notes from their COVID Response Workshop 3/12/20 AMIA COVID-19 Discussion Forum and Community (requires AMIA membership) COVID-19 Navigator Tiger team and their asset classification guide

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