Clinical Decision Support

1. Proposed Profile: Clinical Decision Support

• Proposal Editor: Keith W. Boone
• Profile Editor: Keith W. Boone
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Patient Care Coordination

Summary

<Many people find it easier to write this section last. Use simple declarative sentences. Avoid going into background. If it's more than a dozen lines, it's not a summary.>

<Summarize in one or two lines the existing problem . E.g. "It is difficult to monitor radiation dose for individual patients and almost impossible to assemble and compare such statistics for a site or a population.">

<Demonstrate in a line or two that the key integration features are available in existing standards. E.g. "DICOM has an SR format for radiation dose events and a protocol for exchanging them.">

<Summarize in a few lines how the problem could be solved. E.g. "A Radiation Dose profile could require compliant radiating devices to produce such reports and could define transactions to actors that collect, analyze and present such information.">

<Summarize in a line or two market interest & available resources. E.g. "Euratom and ACR have published guidelines requiring/encouraging dose tracking. Individuals from SFR are willing to participate in Profile development.">

<Summarize in a line or two why IHE would be a good venue to solve the problem. E.g. "The main challenges are dealing with the chicken-and-egg problem and avoiding inconsistent implementations.">

2. The Problem

A wide class of problems in healthcare are described as being in the area of clinical decision support. However, integration of these capabilities into EHR applications has been slow due to the inability to integrate clinical decision support into HIT applications.

Most focus on integration of CDS has been in the area of describing the logic that is used to solve the problems. However, the exchange of CDS algorithms has failed to make decision support more readily available.

What is first needed is a common way to integrate CDS into healthcare IT applications to support its use to solve problems such as:

1. Drug and Allergy interaction detection
2. Forecasting a vaccine schedule
3. Identification of patients eligible for participation in reseach or other programs.
4. Cost effective selection of antibiotics based on recent institutional data

The key is not in how to express the decision support logic, but to integrate that logic into a healthcare IT application in a standard fashion.

3. Key Use Case

<Describe a short use case scenario from the user perspective. The use case should demonstrate the integration/workflow problem.>

<Feel free to add a second use case scenario demonstrating how it “should” work. Try to indicate the people/systems, the tasks they are doing, the information they need, and hopefully where the information should come from.>

<To focus on the end user requirements, and not just the solution mechanism, and to give people trying to understand the applications concrete examples of the problems existing and the nature of the solution required. State the problem domain and outline the workflows in terms of the people, tasks, systems and information involved. Feel free to describe both the current “problematic” workflow as well as a desirable future workflow where appropriate. Remember that other committee members reviewing the proposal may or may not have a detailed familiarity with this problem. Where appropriate, define terms.>

4. Standards & Systems

<List relevant standards, where possible giving current version numbers, level of support by system vendors, and references for obtaining detailed information.>

<List systems that could be involved/affected by the profile.>

5. Technical Approach

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<Outline how the standards could be used/refined to solve the problems in the Use Cases. The Technical Committee will be responsible for the full design and may choose to take a different approach, but a sample design is a good indication of feasibility.>

<If a phased approach would make sense indicate some logical phases. This may be because standards are evolving, because the problem is too big to solve at once, or because there are unknowns that won’t be resolved soon.>

Existing actors

<Indicate what existing actors could be used or might be affected by the profile.>

New actors

<List possible new actors>

Existing transactions

<Indicate how existing transactions might be used or might need to be extended.>

New transactions (standards used)

<Describe possible new transactions (indicating what standards would likely be used for each. Transaction diagrams are very helpful here. Feel free to go into as much detail as seems useful.>

Impact on existing integration profiles

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New integration profiles needed

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Breakdown of tasks that need to be accomplished

<A list of tasks would be helpful for the technical committee who will have to estimate the effort required to design, review and implement the profile.>

6. Support & Resources

<List groups that have expressed support for the proposal and resources that would be available to accomplish the tasks listed above.>

7. Risks

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8. Open Issues

<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>

<If there are no Open Issues at Evaluation Time, it is usually a sign that the proposal analysis and discussion has been incomplete.>

9. Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA

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