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Submitting WG/Project/Implementer Group

FHIR-I

Justification and Objectives

2020 is an important year in the PAMA Imaging requirements timeline and, as many practices are relatively unprepared for PAMA, there is an opportunity for vendors to bring a CDS Hooks and SMART Web Messaging enabled solution to the market.

One objective of this track would be to facilitate a participant testing such a solution against reference materials (the CDS Hook sandbox, the SMART app launcher, etc).

Another objective would be to understand where new features are needed in the reference solutions.

This track will use what version of FHIR.

R4

Clinical input requested (if any)

No input is needed, although feedback from clinicians would be most welcome.

Related tracks

If there is a separate, CDS Hooks, track - seating near them would be ideal.

Proposed Track Lead

Carl Anderson, carl.anderson@microsoft.com.

Expected participants

Since this is the first ever CMS connectathon, it's hard to predict from previous events who will want to attend this track.  However, given that PAMA Imaging should be a very popular topic in 2020, I expect there will be great interest among both EHR vendors and QCDSM software providers.

Track Orientation

A webinar will be hosted (tentatively) on 2019-12-12 at noon Central to share further participation information about this track. Use this Go To Meeting Link for Track Orientation.


An ics file can be downloaded and saved to your calendar: SMART_Web_Messaging_Track_Orientation.ics

Join the webinar online: HERE

Slides: TODO

Recording: TODO

System Roles

EHR Vendors

EHR vendors will be expected to have a working order-select hook in place if they wish to test the reference CDS hook service.  To test the SMART Web Messaging functionality of the reference solution, they should have HTML5 Web Messaging also enabled in their user interface.

QCDSM / SMART App Vendors

QCDSM vendors who intend to test a CDS Hook Service should have an order-select hook service ready to respond to (at least) the scenarios outlined below.  SMART App vendors should have an app capable of performing a SMART launch to inherit EHR context.  Ideally, the SMART app should also be able to update the EHR based on selection changes made in-app via SMART Web Messaging.

All Participants

It wouldn't hurt any of the track participants to complete the codelab outlined here:
https://github.com/microsoft-healthcare-madison/demo-auc-app/blob/documentation/codelab.md

This set of codelab exercises should take 2 to 4 hours to complete and will provide familiarity with the reference materials and the relevant APIs and documentation.

Scenarios

The following scenarios will take advantage of the code provided in the companion codelab wherever possible.  In some cases, minor modifications to the code may be needed, but in many no changes are required.

EHR Vendors

Scenario 1 - order-select hook

Precondition

Implement the order entry, order-select CDS hook.

Precondition

Connect the reference CDS hook found in codelab v2.0: https://github.com/microsoft-healthcare-madison/demo-auc-app

Action

Select a diagnosis of SNOMED 279039007 (low back pain) and image order of CPT 72133 (CT lumbar - no contrast).

Success

EHR user interface displays a warning card, indicating that the selected order is outside of guidelines.

Bonus

TBD

Scenario 2 - SMART app launch

Precondition

Satisfy all preconditions in Scenario 1.

PreconditionRun the reference SMART App service found in codelab v3.0: https://github.com/microsoft-healthcare-madison/demo-auc-app

Action

Select a diagnosis of SNOMED 279039007 (low back pain) and image order of CPT 72133 (CT lumbar - no contrast).

ActionClick the SMART app launch link on the displayed card

Success

The linked app launches, either within an embedded iframe or within a new tab in the EHR.  Focus is changed to the new app.

Bonus

Closing the launched app returns focus to the order entry screen.

Scenario 3 - SMART Web Messaging

Precondition

Satisfy all preconditions in Scenario 2.

Action

Select a diagnosis of SNOMED 13213009 (congenital heart disease) and image order of CPT 71275 (cta with contrast material) in the mock EHR.

ActionClick the SMART app launch link on the displayed card.
ActionChange the selected order in the SMART app to 75561 (cardiac mri)
ActionClick the button to 'update the order', which will have an effect in the mock EHR.

Success

The app closes automatically, returning focus to the EHR.

SuccessThe order now contains 75561 (cardiac mri) and not 71275 (cta with contrast material).

Bonus

Closing the launched app returns focus to the order entry screen.

QCDSM Vendors

Scenario 1 - order-select CDS hook service

Precondition

The combination of codes (diagnosis: SNOMED 279039007 and order: CPT 72133) is rated as not-appropriate.

PreconditionYou have implemented a CDS Hook service for order-select to evaluate order appropriateness and return a card for non-appropriate selections.

Precondition

You have configured the CDS hook sandbox to use your service.

Action

Select a diagnosis of SNOMED 279039007 (low back pain) and image order of CPT 72133 (CT lumbar - no contrast).

Success

Sandbox displays a warning card, indicating that the selected order is outside of guidelines.

Bonus

TBD

Scenario 2 - CDS hook systemAction

Precondition

The combination of codes (diagnosis: SNOMED 13213009 and order: CPT 75561) is rated as appropriate.

PreconditionWhen a user has selected an appropriate combination of order and diagnosis, a system action inserts evidence of guideline consultation into the order automatically.

Precondition

Configure the CDS hook sandbox to use your service.

PreconditionYou have disabled the default pama-imaging service in the CDS Hooks sandbox.

Action

Select a diagnosis of SNOMED 13213009 (congenital heart disease) and image order of CPT 75561 (cardiac mri).

Success

The CDS Hooks Sandbox displays the appropriate PAMA rating.

Bonus

Your service may chose to return a card for appropriate selections, to indicate to the user that their selection meets guidelines.

Scenario 3 - SMART launch

Precondition

Your app is configured to use the SMART launch framework, providing a launch endpoint.

PreconditionYour launch endpoint initiates a SMART launch, requesting the provider and patient scopes.
PreconditionUsing the SMART App Launcher tool, you have configured your launch URL.

Precondition

You have also pre-selected a patient and a provider in the SMART App Launcher.

Action

Click the Launch App button in the SMART App Launcher

Success

The SMART App Launcher displays a mock EHR frame around your embedded app.

Bonus

Your app displays a provider and patient picker when these have not been pre-selected in the SMART App Launcher configuration.

TestScript(s)

Functionality is currently tested and confirmed by using helper tools, such as the SMART App Launcher and the CDS Hooks sandbox.

Security and Privacy Considerations

For a SMART launch to take advantage of the openid scope, the connected app must enable OAuth openid connect in advance.

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