Short Description

Continue the testing and use of FHIR-based Quality Measures for use in Quality Measurement programs, including CMS, Gaps in Care (GIC) and Clinical Decision Support (CDS) Use Cases. The focus of this Connectathon will be to:

  • Continue testing of Measure evaluation using QI-Core 4.1.1 compliant FHIR servers
  • Test Measure Terminology Service capabilities, including version-specific expansion.
  • Test PlanDefinition $apply semantics
  • Test QI-Core Authoring Capabilities
  • Test of potential drug-drug interaction clinical decision support (PDDI CDS) at three points in the CPOE workflow: patient-view, order-select, and order-sign

Long Description

The Clinical Reasoning Track will continue focused testing of quality measures using data available from QI-Core 4.1.1 compliant FHIR servers:

  • Test the use of FHIR resources in alignment with FHIR R4 Implementation Guides (IG) such as QI-Core IG, Quality Measure IG and the Data Exchange for Quality Measures (DEQM) IG.

  • Test the following 2023 Reporting CMS Measures for QI-Core:
    • Eligible Clinician (EC) Measures
      CMS2v13: Preventive Care and Screening: Screening for Depression and Follow-Up Plan
      CMS22v12: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
      CMS127v12: Pneumococcal Vaccination Status for Older Adults
      CMS128v12: Anti-depressant Medication Management
      CMS133v12: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
      CMS142v12: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
      CMS144v12: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
      CMS146v12: Appropriate Testing for Children with Pharyngitis
      CMS149v12: Dementia: Cognitive Assessment
      CMS155v12: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
      CMS156v12: Use of High-Risk Medications in the Elderly
      CMS157v12: Oncology: Medical and Radiation - Pain Intensity Quantified
      CMS165v12: Controlling High Blood Pressure
      CMS249v6: Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
      CMS347v7: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
      CMS50v12: Closing the Referral Loop: Receipt of Specialist Report
      CMS645v7: Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy
      CMS646v4: Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer
      CMS69v12: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
      CMS771v5: Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia
      CMS951v2: Kidney Health Evaluation

    • Eligible Hospital (EH) Measures
      CMS71v13: Anticoagulation Therapy for Atrial Fibrillation/Flutter
      CMS816v3: ​​​Hospital Harm - Severe Hypoglycemia
      CMS190v12: ​​Intensive Care Unit Venous Thromboembolism Prophylaxis
      CMS334v5: Cesarean Birth
      CMS506v6: Safe Use of Opioids - Concurrent Prescribing
      CMS819v2: Hospital Harm-Opioid Related Adverse Events
      CMS986v2: Global Malnutrition Composite Score
      CMS996v4: ​​Appropriate Treatment for STEMI Patients in the ED

    1. Gather: The Reporting System queries the Clinical Data Repository for the data required to evaluate the measure
    2. Evaluate: The Reporting System evaluates the quality measure, producing a MeasureReport resource
    3. Report: The Reporting System posts the completed MeasureReport to the Receiving System

      If you are interested in testing past measures, visit:
       https://docs.google.com/spreadsheets/d/1DocNOIX3ZYWCzOxSHw00sl21WHWx5SeazrlSCUcjqqs/edit#gid=852465089

  • Test measure capabilities, for example:
  • Utilize test cases from the Measure Authoring Development Integrated Environment (MADiE), which supports QI-Core profile informed authoring and testing of FHIR measures.

There will also be tests of potential drug-drug interaction clinical decision support (PDDI CDS) at three points in the CPOE workflow:

  • PDDI CDS service subscription
  • PDDI CDS request at patient-view
  • The "basic" order-sign scenario in the PDDI CDS Implementation guide
  • The "advanced" scenario that coordinates PDDI CDS at order-select and order-sign

Type

Test an Implementation Guide


Related Tracks?

Care Planning, Public Health, CDS Hooks, Da Vinci DEQM Gaps in Care and Vulcan Schedule of Activities

Call for participants

Providers, Payers, and other related HIT vendors


Track Prerequisites

By role for testing of quality measures:


By role for PDDI CDS:

  • Clinical data repository: R4
  • Clinical Reasoning Engine: CDS Hooks services for one potential drug-drug interaction use case
  • EHR client: able to call patient-view, order-select, and/or order-sign CDS Hooks referring to a patient whose data is accessible via an R4 FHIR server

Track Lead(s)

Bryn Rhodes (testing of quality measures)


Track Lead Email(s)

Bryn Rhodes: bryn@databaseconsultinggroup.com or fhir@icf.com 


Specification Information

Implementation Guides:


Zulip stream

Testing of Quality Measures: https://chat.fhir.org/#narrow/stream/179220-cql 


Track Kick off Call

DATE/TIMESESSION TYPEARTIFACTS
Wed., April 12th
10 AM ET
Track Kickoff
Wed., April 19th
10 AM ET
Working/Planning 
Wed., April 26th
10 AM ET
Working/Planning 
  • Recording (Passcode: ^&h8T=+D )
  • Overview of Github Repo, VS Code and Connectathon Manager (ConMan)
  • How testing is conducted for the individual use cases planned for the Connectathon
Wed., May 3rd 
10 AM ET
Working/Planning 
  • Recording (Passcode: jFaS0k%r)
  • Demo of eCQM testing tool application 
Meeting Login: https://us02web.zoom.us/j/83645856405?pwd=OHJRdVVtb3BBQTdVaWp5UlBXUEdvUT09
Zoom meeting id: 836 4585 6405
Passcode: 552204

Connectathon Event Artifacts


Slides for Testing Breakout:

***IMPORTANT***
HL7 will have limited internet bandwidth in the hotel meeting space and ask that all attendees upload and/or download their larger web-based content before the actual event. The Clinical Reasoning Track recommends attendees, at a minimum, download these links to their device:

    • Be sure to actually open a CQL file to ensure download of the CQL Language Server ahead of time.

  • Git Hub repository content for testing measures

The track team will also have these files saved onto a flash drive, for those that were unable to download their content ahead of time. HL7 asks attendees not to stream videos, engage in gaming or other activities that will disrupt the limited bandwidth. 


Testing Scenario:

Quality Measure Testing:

System roles:

  • Knowledge Repository
  • Terminology Server
  • Clinical Data Repository
  • Reporting System
  • Receiving System

Scenarios (Exam125FHIR and Exam130FHIR)

Individual and Summary Measure Report

Action: The reporting system uses data requirements from the knowledge repository and value sets from the terminology server to construct and issue FHIR queries against the clinical data repository to retrieve the data of interest for the measure and subject(s).

Action: The reporting system posts data gathered from the clinical data repository to the receiving system.

Action: The reporting system issues an $evaluate-measure to the receiving system to calculate the measure and displays the results.

Precondition: The knowledge repository has measure and library resources loaded. The terminology server has value sets loaded. The clinical data repository has patient information loaded.

Measure content: Exam125FHIR Exam130FHIR

Test data: Exam125FHIR Exam130FHIR

Success Criteria:  The reporting system displays expected results for the selected measure and subject.

Bonus point: The reporting system displays expected population results for all test patients

Multiple Provider Scenario:

Two groups are registered with CMS --
MIPS Group: GroupA / TIN: 00123 (this group is comprised of Practitioner/TIN pairs: John Smith/ TIN 00XXX and Jane Smith/TIN 00YYY)
MIPS Group: GroupB / TIN: 00999 (this group is comprised of Practitioner/TIN pairs: John Smith/TIN 00ZZZ and Kelly Smith/TIN 00YYZ)

Patient Jane Doe has several encounters with Practitioner John Smith - all at the same location/facility and all the encounters have codes related to Medicare Part B

All of the data for the above is coming from a single organization (EIN/TIN 00000) and a single FHIR output from their EHR

Terminology Service Testing

NOTE: The NLM's R4 FHIR Terminology Service will be available for participants to use. Use of this server requires a current UMLS license, as well as access to the UAT instance for the FHIR R4 functionality. Please provide track leads with your UMLS user id so we can coordinate access to the UAT instance. Note also that the above version-specific expand scenario is currently only partially supported by the VSAC's FHIR instance, and testing should be focused on use of the R4 ValueSet resources returned.

BASE URI: https://uat-cts.nlm.nih.gov/fhir/r4
This UAT Base URI is no longer included on the FHIR Terminology Service for VSAC Resources as it has become a public page that points to the production servers. However, the capability statements and other important documentation are included on the FHIR Terminology Service for VSAC Resources page.

Using the UAT base URI, instead of our production server base URI  (https://cts.nlm.nih.gov/fhir/r4), allows our software engineers to respond to issues and make adjustments/corrects in real time, when possible, during the connectathon.

People who have requested UAT permissions will have permissions on the UAT server: https://uat-cts.nlm.nih.gov/fhir/r4, not necessarily on the production server: (https://cts.nlm.nih.gov/fhir/r4).

RequirementTest CaseExpected Outcome

Code System 1: Representation

  • url
  • url&version
  • name
  • status
  • experimental
  • publisher
  • description
  • caseSensitive

TODO (build URL and identify CodeSystem)

CodeSystem resources that conform to ShareableCodeSystem
Content as expected (validate url, version, name, title, experimental, status, publisher, description)

Source of truth for CodeSystem resources being:

  • FHIR specification (for ballot bound code systems)
  • terminology.hl7.org (for HL7 and external code systems)
Code System 3: Retrieve

Code System 4: Search by

  • url
  • url&version
  • identifier
  • name
  • title
  • description
  • code (exact match)


Code System 6: $lookup

Code System 7: $validate-code

Quality Program 1: Representation

Quality Program 2: PublishableLibrary

Quality Program 3: Retrieve



Quality Program 5: $expand

Quality Program 7: $package

Quality Program 8: Release Manfiest

Server Operations 1: metadata?mode=terminology

Server Operations 2: Batch support

Value Set 1: ShareableValueSet



Value Set 2: ComputableValueSet

Value Set 3: ExecutableValueSet

Value Set 4: PublishableValueSet

Value Set 5: Retrieve

Value Set 6: Search by:

  • url
  • url&version
  • identifier
  • name
  • title
  • status
  • description
  • code
  • offset


Value Set 8: $validate-code

  • url
  • valueSetVersion
  • activeOnly
  • displayLanguage
  • code
  • system
  • system-version
  • coding
  • codeableConcept
  • check-system-version
  • force-system-version


Value Set 9: $expand

  • url
  • valueSetVersion
  • activeOnly
  • displayLanguage
  • limitedExpansion
  • default-to-latest-version
  • system-version
  • cehck-system-version
  • force-system-version
  • manfiest
  • expansion
  • includeDraft


Clinical Decision Support Testing:

System roles:

  • Knowledge Repository
  • Terminology Server
  • Clinical Data Repository
  • Clinical Reasoning Engine
  • Healthworker Application

Scenarios (WHO Antenatal Care)

Routine Encounter Decision Support, Step 5 - Quick Check

Action: The healthworker application uses WHO Antenatal Care content from the knowledge repository and terminology server to facilitate delivery of guideline-based care as part of a routine pregnancy encounter. Specifically, the application displays the Questionnaire for Step 05 - Quick Check, pre-populating available data from the clinical data repository based on the current status of the patient.

Action: The user fills out the Quick Check questionnaire, indicating that no danger signs are present. The application issues a PlanDefinition/$apply with the results of the completed Questionnaire to the clinical reasoning engine

Action: The clinical reasoning engine processes the Quick Check PlanDefinition with the given input data and determines the contact can proceed as normal and returns the results.

Precondition: The knowledge repository has WHO ANC content loaded. The terminology server has WHO ANC value sets loaded. The clinical data repository has patient information loaded, and in the expected state of an in-progress routine pregnancy contact.

ANC content: https://build.fhir.org/ig/WorldHealthOrganization/smart-anc/downloads.html

Test data: https://build.fhir.org/ig/WorldHealthOrganization/smart-anc/examples-first-contact.html#step-05-quick-check

Success Criteria:  The healthworker application displays guidance provided by the clinical reasoning engine, indicating no danger signs are present and the contact can proceed as normal.

Bonus point: The healthworker application has content from multiple implementation guides loaded to demonstrate inter-leaving decision support based on the common process model described in CPG.
Bonus point: The healthworker application uses the new PlanDefinition/$apply semantics (i.e. no CarePlan returned, only a RequestGroup)

Variant: User indicates a symptom that is a danger sign, decision support returns referral to emergency department

Security and Privacy Considerations:

This track will use all synthetic data and open FHIR endpoints


Testing Scenario (PDDI CDS):

PDDI CDS Clinical Decision Support Testing:

System roles:

  • Knowledge Repository
  • Terminology Server
  • Clinical Data Repository
  • Clinical Reasoning Engine
  • Healthworker Application

Scenarios (PDDI CDS)

Subscribe to CDS Services

Action: The healthworker application subscribes to PDDI CDS services from the clinical reasoning engine.   

Precondition:  The clinical reasoning engine has loaded the PDDI CDS services for patient-view, order-select, and order-sign (all to handle the warfarin-NSAIDS PDDI for this run).

Success Criteria:  The healthworker application receives a valid CDS Hooks service response listing all three services, including prefetch templates.

Example: CDS Service subscribe request: https://cds.ddi-cds.org/cqf-ruler-r4/cds-services 


Patient-view

Action: The healthworker application uses PDDI CDS from the clinical reasoning engine  to deliver suggestions about PDDIs based on data about a specific patient in the EHR at the time that a patient chart is loaded (patient-view). 

Precondition:  The clinical reasoning engine has loaded the PDDI CDS service for patient-view (warfarin-NSAIDS for this run). The clinical data repository has patient information loaded and has subscribed to the PDDI CDS service for patient-view. 

Success Criteria:  The healthworker application displays guidance provided by the clinical reasoning engine, indicating the appropriate branch of the PDDI CDS rule.

Example:

Pre-condition:

  • the patient has at least one MedicationStatement or MedicationRequest in the EHR within 100 days of "today" (the date the CDS request is made) that is one of the values listed in the "Warfarins" value set (VSAC '2.16.840.1.113762.1.4.1213.8') 
  • the patient has at least one MedicationStatement or MedicationRequest in the EHR within 100 days of "today" (the date the CDS request is made)  that is one of the values listed in "NSAIDs" value set (VSAC '2.16.840.1.113762.1.4.1213.9')

POST https://cds.ddi-cds.org/cqf-ruler-r4/cds-services/warfarin-nsaids-cds-patient-view

{
"hookInstance": "<id>",
"hook": "patient-view",
"fhirServer": "<FHIR SERVER WITH PATIENT DATA",
"fhirAuthorization": {
<AUTH INFORMATION>
"scope": "patient/*.* user/*.*",
"subject": "patient"
},
"userId": "Practitioner/<id>",
"patientId": "<id>",
"context": {
"userId": "Practitioner/<id>",
"patientId": "<id>",
"encounterId": "<id>"
}
}

Expected response: CDS Cards describing a potential DDI and suggesting management options.

The "basic" order-sign scenario - order-sign only 

 Action: The healthworker application uses PDDI CDS from the clinical reasoning engine  to deliver suggestions about PDDIs based on data about a specific patient in the EHR at the time that a new medication order is being signed (order-sign).

Precondition:  The clinical reasoning engine has loaded the PDDI CDS service for order-sign (warfarin-NSAIDS for this run). The clinical data repository has patient information loaded and has subscribed to the PDDI CDS service for order-sign. 

Success Criteria:  The healthworker application displays guidance provided by the clinical reasoning engine, indicating the appropriate branch of the PDDI CDS rule.

Example:

Pre-condition:

  • the patient has at least one MedicationStatement or MedicationRequest in the EHR within 100 days of "today" (the date the CDS request is made) that is one of the values listed in the "Warfarins" value set (VSAC '2.16.840.1.113762.1.4.1213.8') 
  • the patient has at least one MedicationStatement or MedicationRequest in the EHR within 100 days of "today" (the date the CDS request is made)  that is one of the values listed in "NSAIDs" value set (VSAC '2.16.840.1.113762.1.4.1213.9')

POST https://cds.ddi-cds.org/cqf-ruler-r4/cds-services/warfarin-nsaids-cds-sign

{
   "hookInstance": "<id>",
"hook": "order-sign",
"fhirServer": "<FHIR SERVER WITH PATIENT DATA",
"fhirAuthorization": {
<AUTH INFORMATION>
"scope": "patient/*.* user/*.*",
"subject": "patient"
},
"userId": "Practitioner/<id>",
"patientId": "<id>",
"context": {
"userId": "Practitioner/<id>",
"patientId": "<id>",
"encounterId": "<id>"
}
    "extension": {
    "pddi-configuration-items": {
        "filter-out-repeated-alerts": false,
        "show-evidence-support": true,
        "alert-non-serious": true
    }
    },
    "context": {
"userId": "Practitioner/<id>",
"patientId": "<id>",
"encounterId": "<id>"  
    "draftOrders": {
        "resourceType": "Bundle",
        "entry": [
        {
            "resource": {
            "resourceType": "MedicationRequest",
            "id":"test-ketorolac-med-request",
            "meta":{
                "lastUpdated":"2022-12-04T13:25:40.845-04:00"
            },
            "text":{
                "status":"generated",
                "div":"<div xmlns=\"http://www.w3.org/1999/xhtml\">Ketorolac Tromethamine 10 MG Oral Tablet (rxnorm: 830422) </div>"
            },            
            "authoredOn": "2022-12-04",
            "status":"draft",
            "intent":"order",
            "subject": {
              "reference": "Patient/<id>"
            },
            "dosageInstruction": [
                {
                "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "d",
                    "boundsPeriod": {
                    "start": "2022-12-15"
                    }
                }
                },
                "doseAndRate": [
                {
                "doseQuantity": {
                    "value": 1,
                    "system": "http://unitsofmeasure.org",
                    "code": "{pill}"
                }
                }
                ]
            }
            ],
            "medicationCodeableConcept": {
                "coding": [
                {
                "display": "Ketorolac Tromethamine 10 MG Oral Tablet",
                "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
                "code": "834022"
                }
                ],
                "text": "Ketorolac Tromethamine 10 MG Oral Tablet"
            }
            }
        }
        ]        
    }
    },
    "prefetch": {
    }
}

Expected response: CDS Cards describing a potential DDI and suggesting management options.


The "advanced" scenario - coordination of order-select and order-sign

Action: The healthworker application uses PDDI CDS from the clinical reasoning engine  to deliver suggestions about PDDIs based on data about a specific patient in the EHR at the time that a new medication order is being selected (order-select).

Precondition:  The clinical reasoning engine has loaded the PDDI CDS services for order-select and order-sign (warfarin-NSAIDS for this run). The clinical data repository has patient information loaded and has subscribed to the PDDI CDS service for order-sign. The healthworker application has configured the order-sign CDS Hook by setting the filter-out-repeated-alerts setting for pddi-configuration-items to "false" and the order-select CDS Hook by setting cache-for-order-sign-filtering to "true"

Success Criteria:  The healthworker application displays guidance provided by the clinical reasoning engine at order-select, indicating the appropriate branch of the PDDI CDS rule, but does not repeat the information at order-sign.

Pre-condition:

  • the patient has at least one MedicationStatement or MedicationRequest in the EHR within 100 days of "today" (the date the CDS request is made) that is one of the values listed in the "Warfarins" value set (VSAC '2.16.840.1.113762.1.4.1213.8') 
  • the patient has at least one MedicationStatement or MedicationRequest in the EHR within 100 days of "today" (the date the CDS request is made)  that is one of the values listed in "NSAIDs" value set (VSAC '2.16.840.1.113762.1.4.1213.9')

First POST

{
  "hookInstance": "<id>",
    "hook": "order-select",
  "fhirServer": "<FHIR SERVER>/fhir/",
    "fhirAuthorization": {
<AUTH INFO>
      "scope": "patient/*.* user/*.*",
        "subject": "patient"
    },
  "userId": "Practitioner/<id>",
  "patientId": "<id>",
    "extension": {
    "pddi-configuration-items": {
        "cache-for-order-sign-filtering": true,
        "show-evidence-support": true,
        "alert-non-serious": true
    }
    },
    "context": {
  "userId": "Practitioner/<id>",
  "patientId": "<id>",
  "encounterId": "<id>",
    "selections": [
        "MedicationRequest/ketorolac-draft-order-test"
    ],
    "draftOrders": {
        "resourceType": "Bundle",
        "entry": [
        {
        "resource": {
            "resourceType": "MedicationRequest",
            "id": "ketorolac-draft-order-test",
            "authoredOn": "2022-12-11",
            "status": "draft",
            "subject": {
          "reference": "Patient/<id>"
            },
            "dosageInstruction": [
            {
            "doseQuantity": {
                "value": 1,
                "system": "http://unitsofmeasure.org",
                "code": "{pill}"
            },
            "timing": {
                "repeat": {
                "frequency": 1,
                "period": 1,
                "periodUnit": "d"
                }
            }
            }
            ],
            "medicationCodeableConcept": {
            "text": "Ketorolac Tromethamine 10 MG Oral Tablet",
            "coding": [
                {
                "display": "Ketorolac Tromethamine 10 MG Oral Tablet",
                "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
                "code": "834022"
            }
            ]
            }
        }
            }
        ]
    }
    },
    "prefetch": {
    "item2": {
        "resourceType": "Bundle",
      "id": "<id>",
        "meta": {
        "lastUpdated": "2021-05-01T09:38:54.162+00:00"
        },
        "type": "searchset",
        "total": 1,
        "link": [
        {
        "relation": "self",
        "url": "<FHIR SERVER>/fhir/Condition?patient=1496"
            }
        ],
        "entry": [
        {
        "fullUrl": "<FHIR SERVER>/fhir/Condition/140000",
        "resource": {
            "resourceType": "Condition",
          "id": "<id>",
            "meta": {
            "versionId": "1",
            "lastUpdated": "2021-05-01T09:04:41.038+00:00"
            },
            "clinicalStatus": "active",
            "verificationStatus": "differential",
            "code": {
            "coding": [
                {
                "system": "http://snomed.info/sct",
                "code": "12847006",
                "display": "Acute duodenal ulcer with hemorrhage"
            }
            ]
            },
            "subject": {
          "reference": "Patient/<id>"
            },
            "recordedDate": "2021-05-01"
        },
        "search": {
            "mode": "match"
        }
            }
        ]
    },
    "item4": {
        "resourceType": "Bundle",
      "id": "<id>",
        "meta": {
        "lastUpdated": "2022-12-04T07:45:43.383+00:00"
        },
        "type": "searchset",
        "total": 1,
        "link": [
        {
        "relation": "self",
      "url": "<FHIR SERVER>/fhir/MedicationStatement/_search"
            }
        ],
        "entry": [
        {
      "fullUrl": "<FHIR SERVER>/fhir/MedicationStatement/160003",
        "resource": {
            "resourceType": "MedicationStatement",
          "id": "<id>",
            "status": "active",
            "medicationCodeableConcept": {
            "coding": [
                {
                "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
                "code": "855324",
                "display": "Warfarin Sodium 4 MG Oral Tablet"
            }
            ]
            },
            "subject": {
          "reference": "Patient/<id>"
            },
            "effectivePeriod": {
            "start": "2022-12-03T00:00:00+00:00",
            "end": "2023-04-27T00:00:00+00:00"
            },
            "dosage": [
            {
            "text": "4 times daily",
            "doseAndRate": [
                {
                "doseQuantity": {
                "value": 30.0
                }
            }
            ]
            }
            ]
        }
            }
        ]
    }
    }
}

Second POST https://cds.ddi-cds.org/cqf-ruler-r4/cds-services/warfarin-nsaids-cds-sign

  • POST Body would be the same as for the "basic" scenario above but with "filter-out-repeated-alerts": false

Expected response: CDS Cards describing a potential DDI and suggesting management options.

Security and Privacy Considerations:

This track will use all synthetic data and open FHIR endpoints.