Clinical Decision Support
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September 2023 Ballot

  • Discuss and potentially address use cases that aren't traditionally seen as guideline-based care (i.e. generalize to expressing a Computable Care Process?)
  • Updated Checklists - Bryn
  • Infrastructure-level - Bryn
    • Refactor to use CRMI IG
    • Refactor to use SDC
    • Example refresh/fixes
    • General errata/bitrot
    • Update to the latest publisher (no spreadsheets, use templates and markdown)
  • New types of examples? Multi-CPG examples?
  • Updated Capability Statements
    • Specifically identifying roles and "services" for enabling/delivering guideline-based care
  • Apply operation updates
  • Elaborate/expand Case Feature Definition, especially relationship to PlanDefinition and Questionnaire
  • Expand CPG grammar with implementation feedback - Derek
    • Specifically - Stop an order generally
    • NOTE: This is an especially important and potentially difficult use case that we should prioritize for this STU2 update
    • Gather specific use cases we want to support
      • Stop a particular medication (Aspirin)
      • Change a particular medication (ANC Iron Supplement) - Done using a correlated Stop and Start
      • Stop a particular therapy (servicerequest)
      • Change a particular therapy - Done using a correlated Stop and Start
      • Recommend that changes are always done using a correlated Stop and Start
    • Documenting a clinical assessment as part of the workflow
      • CPGClinicalImpression but there is no activity model for adding it to a CPG
  • Usage updates/case studies? - Maria Michaels
    • Examples of where we know CPG has been used
    • Getting any case studies from vendors that would be willing to share
  • Patterns...
  • Potentially add discussion of regulatory/policy considerations?
  • Assessment of relationship/interaction with
    • EBM-on-FHIR - Especially documenting and discussing the touchpoints between an EBMRecommendation and a CPGRecommendation
    • eCaseReport
    • MedMorph
    • MCC
    • QM/DEQM
    • BPM+
    • CDS Hooks
    • OpenCDS - https://www.opencds.org/
    • Label2Enable - https://label2enable.eu/ EU-led initiative operationalizing an ISO specification about regulation of software-based therapeutics
  • Discussion of auditing
    • How auditing would be represented
    • How auditing would be expected to be applied to each element of the grammar


https://hl7.org/fhir/uv/sdc/artifacts.html#behavior-capability-statements

Could usefully abstract the sequence diagrams from ANC for generic processes:

The above are implementation side, would also need to define actors for

  • CPG Authoring (potentially derivative of CRMI Artifact Authoring Repository)
  • CPG Execution
  • CPG Application
  • CPG Clinical Data Repository
  • CPG Artifact Repository (derivative of CRMI Artifact Repository)
  • CPG Terminology Service (derivative of CRMI Artifact Terminology Service)
  • CPG Manager (analogous to SDC Form Manager) that combines the capabilities of a CRMI Publishable Artifact Repository and a CRMI Artifact Terminology Service)

As part of this, we would identify the relationship/overlap/boundary with SDC roles


Workstreams:

  • Template update (pure publisher work)
  • Checklist update
    • Input/Output expectations - Bryn
    • Survey of tools (data dictionary, decision tables, test case descriptions, flow diagrams)
  • Services
  • Operations
  • Patterns/Use Cases
  • Case Studies
    • Known implementations
      • A short description of the intended use cases (therapeutic area, workflow target)
      • A brief overview of technology used (e.g. Java open source)
      • If possible/willing, a summary of any challenges/opportunities the project/usage highlighted
        • 1.    What is the use case? 
        • 2.    Where is it being used (e.g., healthcare organization, EHR platform)? 
        • 3.    How is it being used?
        • 4.    Any feedback on usage (including pilot testing results)?
        • 5.    Any specific technical challenges with implementing the specification?
  • Relationships


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