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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
ACTS LHS cycle
More detailed ACTS current/future state LHS/Knowledge Ecosystem Cycle
Magic evidence ecosystem diagram visualizing key AHRQ actors and offerings, standards, methods, platform, other actors on top of 'evidence ecosystem diagram'
Quality Ecosystem - FHIR Standards (Maria Michaels version)
Brian Alper/COKA FHIR Diagrams
Mary Butler/UMN-EPC Ecosystem Diagram
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).
4. Quality Ecosystem - FHIR Standards (Maria Michaels version)
5. /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 - SRDR+/COKA-enabled Enhancements focused on Collaborative Participant Key Targets (anticoagulation, triage and testing in ED/Ambulatory settings)
[DOC search hyperlink]
B. Ecosystem Needs, Enhancement Opportunities and Potential Concept Demo
| Ecosystem Step | High Priority Enhancement Needs/Opportunities1 | Potential SRDR+/COKA-enabled Enhancements | Potential Stakeholder-driven Proof of Concept Demo (for Key Targets)2 | Other Notes/Comments |
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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
- Identify research gaps that require additional attention
| - 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
- If evidence is in a computable form, can better understand and describe nature of research gap (so it can be filled).
| - 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, triage. [e.g., leverage Doc Search, other tools on Evidence/Guidance CoP page to identify the pertinent evidence]
- 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.
- Identify communities that might do a test to refine AI algorithms to do these kinds of tags [Lisa Lang for more details]
- Could start with simple, higher-level structures to get things rolling, then, over time make the standards more finer grained regarding PICO details.
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| 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.
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| Develop Computable Guidance (e.g., CDS/eCQMs, other computable process enablements and assessments) |
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| - 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.
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| Implement CDS/eCQMs | - Care delivery participants need mechanisms to convey priority needs for which they need guidance/support to those who are producing that information.
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Analyze/Use Care Results (report, produce evidence) |
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| - Those who provide evidence (e.g., study authors) capture data using standard PICO tags so that after-publication coding isn't required. Reserach funder (NIH, PCORI could require this. Have ACEP pilot this with triage-related articles in JACEP?)
| [cautionary note: getting structure into journal articles (e.g., structured abstracts) have been challenging - perhaps even more challenging for this level of standardization] |
| Cross-cutting Issues |
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1By those doing the work - e.g., EPCs, VA/UMN/Health Centers, Agile KE teams, NACHC/ACEP/EvidenceCare, many others
2More information about 'building blocks' for creating components of this 'fantasy' (e.g., standards, sources for inputs/outputs, tools/methods platforms) is on the Community of Practice webpages (see navigation bar left side of this page), and in this emerging catalog from the COVID-END project
computable evidence slide.pptx