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-32322Getting 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-32645Getting issue details...
Allow EvidenceVariable.characteristic.definitionReference to reference Any resource
Add characteristic.type 0..1 CodeableConcept to EvidenceVariable
Change EvidenceVariable.characteristicCombination to CodeableConcept
- - FHIR-32645Getting issue details... STATUS
- 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
- Dublin Core Metadata Initiative – https://www.dublincore.org/specifications/dublin-core/dcmi-terms/#section-3
- Schema.org - https://schema.org/CreativeWork
- Zenodo – https://zenodo.org/record/4474373/export/schemaorg_jsonld
- 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-32322Getting issue details...
- 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."
- Metadata standards and implementations considered inlcuded
- 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