January 2024 Ballot


TaskAssigned ToDue
Grammar changes (expand to include stop)BrynEnd of Nov
Refactor to use CRMIBrynEnd of Nov
Fix bugs (including immunization)TaylorEnd of Nov
ChecklistsBrynEnd of Nov
Pull out examplesTaylorEnd of Nov
Relationships to other initiativesMariaEnd of Nov
Capability StatementsBryn
$applyTaylor
$questionnaireBrenin
AuditDerek
Case features (better documentation & guidance)Rob
Extension to clinical reasoning on FHIR (how to use CPG w/ CDS Hooks)Brian
Operation test casesBrian
  • 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
  • New types of examples? Multi-CPG examples?
    • Pull examples (other than illustrative examples for profiles) into their own IGs instead of having a "multi-ig ig"
    • Only the Activity Examples (and any others required for demonstrating use of a CPG profile) would remain, all the other examples would be their own IGs
    • Would they be balloted themselves, or would they be fhir.org IGs?
    • Would need to follow CRMI (transitively because they would be following CPG)
      • i.e. naming conventions, package ids, canonical roots, etc.
  • Updated Capability Statements
    • Specifically identifying roles and "services" for enabling/delivering guideline-based care
    • Apply operation updates
    • $questionnaire - Given a PlanDefinition and a CaseFeatureDefinition, build a questionnaire to support establishing this
    • Deprecate CarePlan/$apply
  • 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
    • Update immunization activity to use MedicationRequest and deprecate use of ImmunizationRecommendation
  • 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
  • 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:

  • 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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