Date: 5/25/2021

Quarter: Q2

CDS Hosted CQI

Chair - Bryn Rhodes

Scribe - Floyd Eisenberg


  • Overall WGM Agenda review
  • CDS Hooks Connectathon Report out and Project Update/Ballot Reconciliation -
  • FHIRCast Project Update -
  • CDS/CQI Interest in IG Templates Project PSS-1801 - Project to increase consistency & quality of FHIR implementation guides Draft
  • FHIR Trackers, time allowing
  • Tentative - Specific CDS Topics of Interest to International Participants (I.e., non-US)

Meeting Minutes

  1. Agenda review:
    1. added topic for Wednesday Q1: 
      1. Artifact Manifest Profile, Terminology Service, and Repository Service Overview
  2. CDS Hooks Project and Connectathon Report
    1. Isaac Vetter presented an overview of CDS Hooks Service - Project Update/Ballot Reconciliation -
      1. CDS Hooks is invoked via a "hook", evaluates its own logic using FHIR data, and returns clinical decision support via cards
      2. CDS client invokes a hook - invoking agents are mostly EHRs but could be others - using term 
      3. example -
        1. prescriber prescribes a medication
        2. client invokes a CDS hook
        3. CDS services access data on the FHIR server (information about the patient, database about treatment, medication)
        4. returns CDS card with suggestion to change, update, add, etc. medication
      4. FHIR is data model but uses json as a wrapper
      5. Hook triggers define what initiates the hook (e.g., patient view, medication-prescribe, order-sign) - each hook has its own maturity level in the FHIR maturity model 
      6. Can return 0 or more cards (concise summary up to 140 characters, indicator indicating importance of the suggestion, information about the organization or about the source of the data provided
      7. Metadata for each hook 
        1. Prefetch - declare ahead of time, always obtain specific data every time the EHR requests a hook - clients do not have to honor prefetch requests from CDS services. Prefetch assures basic information without decreasing the responsiveness to specific queries
      8. Clinical Reasoning - method for interoperable knowledge artifact; CDS Hook provides remote decision support using Clinical Reasoning CQL libraries to expose functionality through CDS Hooks API.
      9. Status
        1. Continuing to do ballot reconciliation from September 2020 ballot 
        2. Feedback service - ability to save return of card (e.g., override) so EHR can inform the CDS service the ultimate result of the recommendation
    2. CDS Hooks Connectathon Report (Dennis Patterson) - see slide deck:
      1. Participants consistently CoraHealth, Epic and Cerner 
      2. Ability to integrate with multiple CDS clients
      3. Able to increase socialization with increased number of presentations on real world implementations - Potential Drug-Drug Interaction (PDDI) specification, Coverage Requirement Discovery (CRD) implementation, Mitre implementation using CQL to implement CDS Hooks
      4. Raised issues -
        1. Communicating CDS Service failures - why data could not be retrieved - increase status codes
        2. Non-synchronous use cases - discussions about FHIR subscriptions, mechanism for CDS
        3. Communicating FHIR version - currently happens by person-to-person communication; could be identified by the service at run time
        4. Best practices for using CDS Hooks - some concepts are better run in the background (e.g., CRD)
      5. Next steps - version 1.1 ballot resolution, advancing maturity of hooks, increase social networking in Connectathons (presentations), focus on ordering hooks and coordination topics - how do order-select and order-sign work together
    3. Discussion - Specification may benefit from guidance about when to call services and when certain pre-fetch data should be invoked - "what you send versus what you query". Some conditional logic may be helpful to address differences in pre-fetch activities.
  3. FHIRCast Project Update -
    1. Modern, simple context simplification (e.g., assure handling of a specific patient) - challenge to avoid a single user having displays about multiple patients when using multiple applications at the same time - most solutions are vendor-specific. FHIRcast is a modern, FHIR-based content simplification to help industry decrease the need for complex, vendor-specific solutions
    2. FHIRcast specification is stable, used primarily in imaging integration, some EHRs. Test published in STU2 - prototyping exploration of "content sharing" for potential STU 3 - preference for sharing suggested image measurement data for documentation and clinical review purposes. Should FHIRcast be used for information other than context or explore other options for sharing content.  Work ongoing in Infrastructure and Messaging WG.
  4. CDS/CQI Interest in IG Templates Project PSS-1801 - Project to increase consistency & quality of FHIR implementation guides - Bryn Rhodes 
    1. CDS and CQI publish a number of IGs and some of the IGs have resulted in changes to publication templates - representation of knowledge artifacts, generic templates usable across any IG, CQL processing now part of the publisher
    2. Currently a draft project proposal - CQI and CDS now aware - when the proposal is more mature, will need to consider co-sponsorship and/or interested party.
  5. FHIR Trackers (QMIG Tracker Filter):
    1. FHIR-32743 - discussed and not resolved during this call
    2. FHIR-32742 - Persuasive with Mod - add paragraph to clarify the meaning of stable expansion of value sets referenced by the artifacts. 
      1. Ben Hamlin/Floyd Eisenberg: 17-0-1

Action Items

  • None

Adjourned at 12:30 PM UTC, 8:30 AM ET