PSS 1234 Update - Clinical Reasoning & CDS Hooks Unification

PSS 1234 update on the Clinical Reasoning & CDS Hooks unification project.

May 2017 HL7 WGM

Transcript

1. PSS 1234 Clinical Reasoning & CDS Hooks Unification Bryn Rhodes Kevin Shekleton Isaac Vetter HL7 WGM Madrid, Spain 9 May 2017
2. A conflicting message… “I want to do clinical decision support using FHIR” Use Clinical Reasoning! It’s supported by HL7 and supports many use cases! Use CDS Hooks! We’re an open source project with broad support from EHR & CDS providers!
4. The problem with SMART apps Bilirubin Chart Newborns < 120 hours old Bilirubin results that are either: Not documented Outside of the accepted range The user needs to know the app is available The user needs to know the app is relevant The user has to find the app and launch it
5. CDS Hooks A vendor agnostic remote decision support specification Created by the team behind SMART Open source (Apache) Emerging standard with active development and widespread participation from stakeholders
6. CDS Service A service that is: invoked by the EHR via a hook, evaluates its own logic using FHIR data, returns decision support via cards
7. Example Hooks patient-view When a patient’s chart is opened medication-prescribe When a medication is selected for prescription order-review Viewing pending orders for signing
8. CDS Services EHR Med Order Toprol XL 50 mg daily ℞ EHR triggers a CDS hook and invokes a remote service 1 2 CDS Service executes its own rules, leveraging FHIR data as needed EHR FHIR Server 3 Returns CDS cards (rendered and displayed by EHR) $200 per month (patient pays $30) Try HCTZ as first-line Switch to HCTZ Managing hypertension? Launch JNC 8 Rx Pro information card suggestion card smart app link card
9. Cards can contain any combination of information, suggestions, and links
10. CDS Services CDS Service Provider Base https://example.com Discovery /cds-services Service /cds-services/{id}
11. demo.cds-hooks.org
12. Separation of Concerns Concern Owner Workflow & hooks (triggers) EHR
13. Separation of Concerns Concern Owner Workflow & hooks (triggers) EHR CDS logic CDS Service Provider
14. Separation of Concerns Concern Owner Workflow & hooks (triggers) EHR CDS logic CDS Service Provider Initial context data EHR
15. Separation of Concerns Concern Owner Workflow & hooks (triggers) EHR CDS logic CDS Service Provider Initial context data EHR Additional data CDS Service Provider (via FHIR or other sources)
16. Separation of Concerns Concern Owner Workflow & hooks (triggers) EHR CDS logic CDS Service Provider Initial context data EHR Additional data CDS Service Provider (via FHIR or other sources) CDS presentation EHR
18. 2017 Resolutions Release a 1.0 specification Launch production pilots
19. Argonauts ❤ CDS Hooks The EHR invokes a CDS service via a patient-view hook, resulting in a SMART app link card that the clinician uses to launch the SMART app. Validate and implement the CDS Hooks security model
20. Let’s compare! Clinical Reasoning CDS Hooks Management
21. Let’s compare! Clinical Reasoning CDS Hooks Management Rule definition ✔
22. Let’s compare! Clinical Reasoning CDS Hooks Management Rule definition ✔ Local execution ✔
23. Let’s compare! Clinical Reasoning CDS Hooks Management Rule definition ✔ Local execution ✔ Remote execution ✔ ✔
24. What the?! More ✔ wins, right?
25. broad vs narrow
26. Local Decision Support Remote Decision Support Clinical Reasoning
27. CDS Hooks References Specification & documentation http://cds-hooks.org Demo sandbox http://demo.cds-hooks.org Source code https://github.com/cds-hooks
28. ” “ © Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information belonging to Cerner Corporation and/or its related affiliates which may not be reproduced or transmitted in any form or by any means without the express written consent of Cerner. 28 Decision Support Service ...We anticipate, based on the growing community and vendor adoption of CDS Hooks, that the approach will be driven heavily by CDS Hooks and may potentially be foundationally CDS Hooks with modifications as needed to meet stakeholder needs… PSS 1234
29. Let’s Unify!
30. Overview of Proposed Changes Clinical Reasoning Remove remote CDS resources and functionality in favor of CDS Hooks CDS Hooks Make changes to address some (but not all) of the needs of Clinical Reasoning
31. Proposed Changes > Clinical Reasoning • Remove ServiceDefinition in favor of CDS Hooks Discovery • Remove GuidanceResponse (replaced by CDS Service response) • PlanDefinition & RequestGroup • Rename label to prefix (consistent with Questionnaire) • Add label (consistent with CDS Hooks)
32. Proposed Changes > CDS Hooks Hooks • Formal definition of a hook (#39) • Define infobutton hook (#35) Discovery • Rename name to title (consistent with FHIR) (#40) • Support ServiceDefinition.useContext (#6) • Support ServiceDefinition.dataRequirement (#47) • Support ServiceDefinition.date (#38)
33. Proposed Changes > CDS Hooks (cont) CDS Service Response • Specify Markdown flavor (#33) • Allow users to ‘unsubscribe’ from CDS (#41) • Allow users to accept, override, prompt, or dismiss Suggestions (#21) • Enhance Suggestions based upon RequestGroup (#43)
34. CDC Opioid Guidelines with CDS Hooks
35. CDC Opioid Guidelines with CDS Hooks
36. Thanks! Slides bit.ly/pss1234-update-may-2017-wgm