Evidence-Based Medicine/Covid-19 Knowledge Accelerator (EBM/COKA) Track Connectathon 27

  • Introduction and Goals

    • Introduction to EBMonFHIR

      • FHIR makes health data interoperable, but what about health evidence?

      • Evidence-based medicine (EBM) is integration of best research evidence with clinical expertise and patient values

      • Evidence = Analyzed Data = Data + Context

      • Data in FHIR is not automatically Evidence in FHIR

      • Evidence is needed to inform Guidance (Guidelines, Decision Support, Patient Decision Aids, CDS)

      • CDS Artifacts SHOULD reference the supporting Evidence else consider regulation as Software-as-a-Device

      • EBMonFHIR extends FHIR to EBM data

      • FHIR Resources for Evidence-Based Medicine (EBM) Knowledge Assets project (EBMonFHIR) was approved on May 16, 2018 as an HL7 project.

      • EBMonFHIR sponsored by 3 HL7 Work Groups

        • Clinical Decision Support (CDS)

        • Clinical Quality Information (CQI)

        • Biomedical Research and Regulation (BRR)

      • Goal: provide interoperability for clinical research (evidence) and recommendations for clinical care

    • Introduction to COVID-19 Knowledge Accelerator (COKA)

      • Multiple global collaborative groups seeking to advance COVID-19 knowledge discovery sought to use FHIR Evidence Resources

      • COVID-19 Knowledge Accelerator is

        • A virtual organization – no cost, no contracts

        • Open, transparent – all meetings

        • A way for any to volunteer to accelerate development and implementation of standards for evidence exchange, especially with attention to COVID-19

    • FHIR Resources for Evidence Expression






    • EBM/COKA Track goals

      • Demonstrate data exchange using Evidence, EvidenceVariable, Group and EvidenceReport Resources to communicate clinical trial and systematic review findings.

      • Demonstrate data exchange using Citation Resource to communicate location of computable biomedical knowledge artifacts.

  • List of participants 

    • Brian S. Alper, Computable Publishing LLC

    • Khalid Shahin, Computable Publishing LLC

    • Joanne Dehnbostel, Computable Publishing LLC

    • Marc Hadley, MITRE Corporation

    • Michelle Caputy, MITRE Corporation
    • Falk von Dincklage, Charité - Universitätsmedizin Berlin
    • Gregor Lichtner, Charité - Universitätsmedizin Berlin
    • Geoff Low, Medidata Solutions, Vulcan
    • Kees van Bochove, The Hyve, FHIRforFAIR
    • Ana Carolina Loyola Briceno Department of HHS, Office of Quality Improvement

Notable Achievements Tuesday May 18, 2021

  • First working session for Citation Resource exchange

    • MITRE Corporation successfully loaded 2 Citation Resources onto FEvIR.net and they were viewed in Citation Viewer
    • Citation.text was not displayed and was determined to be better represented in Citation.citedArtifact.abstract
    • Multiple clarifications of "publisher" were realized:
      • The Publisher listed on CDS Connect is the "original publisher".  Citations to CDS Connect entries had Citation.citedArtifact.publicationForm.publishedIn.publisher data changed to "Agency for Healthcare Research and Quality" and had the original publisher data moved to Citation.citedArtifact.contributorship
      • The Publisher of the citation can be confusing if the citation is copied from one citation repository to another.  If further edits or value-add content is applied then the receiving citation repository is the publisher, but what if the citation resource is just copied intact?
    • An example with a webLocation that was restricted access led to adding restricted code to the articleUrlType value set being addded to the R5 Ballot FHIR change request  FHIR-32322 - Getting issue details... STATUS . Also added code-repository as it was shown in examples.
    • Clarifications shared to use Citation.citedArtifact.publicationForm.publishedIn.title to include the name of the website or database that artifacts are published in.
    • Use of multiple abstracts and classification of abstract type was demonstrated.
    • Discussion of multiple uses of publicationForm to address "original publication form" and "current publication form" if desired.
    • Suggestions to improve FEvIR Platform:
      • Support login methods other than Google
      • Enable editing of Citation Metadata
      • Support adding resources as a bundle and pull out individual resources automatically
    • Suggestions to improve FHIR Specification:
      • adjust articleUrlType codes as noted above
  • First working session for Evidence and EvidenceVariable Resource exchange
    • Charité - Universitätsmedizin Berlin presented draft Evidence, EvidenceVariable and Group Resources to express evidence from meta-analysis and net effect estimates.  Extensive discussion adjusted how to fit the EBMonFHIR model and how to adjust the EBMonFHIR model to better fit this function.
    • Three FHIR trackers created to improve the EvidenceVariable Resource
      • FHIR-32645 - Getting issue details... STATUS  

        Allow EvidenceVariable.characteristic.definitionReference to reference Any resource

      • FHIR-32646 - Getting issue details... STATUS  

        Add characteristic.type 0..1 CodeableConcept to EvidenceVariable

      • FHIR-32647 - Getting issue details... STATUS  

        Change EvidenceVariable.characteristicCombination to CodeableConcept

    • Brief discussion with Vulcan representative regarding coordination across ResearchStudy, EvidenceVariable, Group, and Evidence Resources to support much of the clinical research knowledge representation.
  • Second working session for Citation Resource exchange
    • The MITRE Corporation and Computable Publishing LLC (and COVID-19 Knowledge Accelerator) discussed collaboration to share and work with FHIR resources across organizations. 
    • There was interest in tools that would facilitate search, deduplication, exchanging classifiers, and notifications to changes in content.
    • We discussed the use of FHIR operations (e.g. $apply) and subscriptions (Subscription, SubscriptionTopic, and SubscriptionStatus Resources) as mechanisms for the above operations. 
    • We need to figure out who is building what pieces and how we can share to avoid "reinventing the wheel".  
    • Further discussion of use cases and capabilities that can be shared would be useful for everyone.
    • MITRE has a specific outline of tasks planned, and would like to modularize so pieces could be reused. 

Notable Achievements May 19, 2021

  • Discussion to harmonize metadata standards for Citation Resource
    • Metadata standards and implementations considered inlcuded
    • Specific mapping applied to 15 elements (Contributor, Coverage, Creator, Date, Description, Format, Identifier, Language, Publisher, Relation, Rights, Source, Subject, Title, Type) in Dublin Core specification
    • For 2 of these elements we added recommended changes to the Citation Resource related value sets at   FHIR-32322 - Getting issue details... STATUS
      • for CitedArtifactClassificationType – add code "coverage", display "Coverage" and definition "The spatial or temporal topic of the resource, spatial applicability of the resource, or jurisdiction under which the resource is relevant"
      • for ContributorRole – change Display of author code to "Author/Creator" and change definition to "An entity primarily responsible for making the resource, often called author or creator."
  • Revised and Created full set of resources to express an EvidenceReport
    • COKA-EBM Clinical Outcomes in ACTT-1 Remdesivir RCT EvidenceReport at https://fevir.net/resources/EvidenceReport/156

    • This includes expresssion of 9 Evidence Resources, 7 EvidenceVariable Resources, 2 Group Resources and 1 ActivityDefinition Resource
    • Coding these FHIR Resources allowed us to "correct" mulitple 'mis-use' or 'outdated' interpretations of FHIR concepts from our modeling a year ago, including adding numberAffected element to statistic expression, removal of comparator for '=', confirming units of measure are applied in range elements when needed, and adjusting value sets for codeable concepts.

Now what? -Future Directions

  • Follow through with Jira items noted above to improve Citation and EvidenceVariable Resources based on Connectathon learnings.
  • Complete development of Citation Builder and Citation Viewer on fevir.net to facilitate human-friendly editing and viewing with conversion to/from FHIR Citation json
  • Enable "Exchange Classifiers" function for Citation Builder – explore FHIR Operations as a potential method
  • Explore FHIR Subscription Framework for notification functions
  • Consider when to start Implementation Guide development for Citation and/or Evidence-related Resource use

JOIN US AT  Confluence HL7 COVID-19 Knowledge Accelerator (COKA) Page

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