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

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<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

A key use case for this profile will focus on vaccine forecasting, but this profile can be applied to other use cases as well.

In the vaccine forecast use case, patient information about immunizations, allergies, and relevant conditions is first gathered from the EHR. This information is then transmitted to the Vaccine forecast system. That system responds with validated clinical data used for making the forecast, and one or more possible vaccination schedules.

This generalizes to an interchange where clinical data conforming to a template or input specification is gathered, structured in a standard fashion, and then submitted to a decision making system. The decision making system may generate new clinical information (e.g., validated clinical data), and one or more plans for care or treatment proposals (e.g., a vaccination schedule).

4. Standards & Systems

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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

Clinical Data Source

• Care_Management#Actors.2FTransaction
• PCC_TF-1/QED#Actors.2FTransaction

Clinical Data Consumer

• PCC_TF-1/QED#Actors.2FTransaction

Care Manager

• Care_Management#Actors.2FTransaction

New actors

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Existing transactions

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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

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6. Support & Resources

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7. Risks

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8. Open Issues

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9. Tech Cmte Evaluation

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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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