Clinical Decision Support for Immunization (CDSi ) Clarity, Consistency, and Computability
description
Transcript of Clinical Decision Support for Immunization (CDSi ) Clarity, Consistency, and Computability
Stuart Myerburg
Clinical Decision Support for Immunization (CDSi)
Clarity, Consistency, and Computability
National Center for Immunization & Respiratory Diseases
Immunization Information Systems Support Branch
Translating ACIP Recommendations
Clinical Immunization
Recommendations
Advisory Committee on Immunization Practices (ACIP)
CDS Engine
Translation of scientific language to technical logic is complex and time-consuming
Uniform interpretation is challenging:• Mostly happens independently within each health
information system• Significant variance in system outputs• Outputs frequently don’t match expectations of clinical
SMEs
Bridging the Gap
Computable LogicClinical
Immunization Recommendations
Logic Specificatio
n
Advisory Committee on Immunization Practices (ACIP)
Increase the accuracy and consistency of immunization evaluation and forecasting
Improve the process of accommodating new and/or changed ACIP recommendations
Make it easier to develop and maintain immunization evaluation and forecasting products
Ensure patients receive proper immunizations “The right immunization at the right time”
CDS Engine
Expert Panel Facilitation Approach
40 industry experts
American Immunization Registry Association
(AIRA)
American Academy of Pediatrics (AAP)
Indian Health Service (IHS)
Electronic Health Record (EHR) Vendors
Immunization Information System (IIS) Vendors
IIS Programs
Academic Institutions
Facilitated remote and in-person sessions
Consensus-based decisions “I can
live with and support that”
Three working groups
Logic Specification for ACIP Recommendations
ACIPRecommendations . Schedules
EHR . IIS . HIE
SOFTWARE
BusinessRules
Decision Tables
Process Models
Domain Model
Testing Methodology
Supporting Data
Logic Definition
Technical Framework
Test Cases
The Logic Specification Is … Documentation of current ACIP recommendations (and
clarifications of those recommendations) for healthy children from birth to 18-years-old
A single, complete source for implementer clarification Computable and implementation-neutral
The Logic Specification Is Not … Modification of existing ACIP recommendations Replacement for the role of ACIP National evaluation and forecasting application or other
product Replacement for current software applications
In Logic Specification Scope
Vaccine groups routinely recommended for perfectly healthy children ages 0 to 18 Hepatitis A (Hep A) Hepatitis B (Hep B) Diphtheria, Tetanus, Pertussis (DTaP, Tdap, TD) Pneumococcal Disease (PCV) Poliomyelitis (Polio) Meningococcal Disease (MCV) Mumps, Measles, Rubella (MMR) Varicella Influenza (Flu) Human Papillomavirus (HPV) Haemophilus Influenzae (Hib) Rotavirus
Out of Logic Specification ScopeItem Notes Non-ACIP published rules
State law differences Rules published by other
organizations Rules published in other
countries Local school schedules
Not addressed specifically, however configuration data – known as supporting data in this model – could be adjusted to cover
Adult vaccines Underlying conditions High/increased/special risk series
(e.g. HIB past 5 years, MCV HIV series)
Travel vaccines Vaccine shortages Non-FDA approved vaccines (e.g.
used in clinical trial)
Currently excluded from scope, but candidate for future consideration
Technical Framework
Logic Definition
Supporting Data
Logic Specification Components Abstracted attributes and values
Standard data table definitions Antigen specific values Static definitions Dynamic values
Supporting Data
Technical Framework
Functionality for evaluation/forecasting Thin process models Decision tables Business rules Static Technical “glue” Activity diagrams Static
Logic Definition
Dynamic vs. Static
Technical Framework
Logic Definition
Supporting Data(2012 ACIP Rules)
Supporting Data(2013 ACIP Rules)
Supporting Data(2013 State Rules)
Sample Logic Definition Content: Text
4.2 SKIP TARGET DOSE There are certain times where a Target Dose
can be skipped. In most settings, this occurs when a patient is behind schedule and the total number of doses needed to reach presumed immunity can be reduced. In cases where a Target Dose does not specify Skip Target Dose attributes, the Target Dose cannot be skipped.
Sample Logic Definition Content: Figure
Sample Logic Definition Content: Decision Table
CONDITIONS RULES
Date Administered < Trigger Age Date?
Yes No
OUTCOMESThe Target Dose cannot be skipped.
The Target Dose can be skipped. Target Dose status is Skipped.
DECISION TABLE 4 - 2 CAN THE TARGET DOSE BE SKIPPED?
Logic Specification Audience and Uses
Those with or without immunization evaluation and forecasting engines Refine, clarify, troubleshoot, and verify Develop
Organizational roles Program managers Business analysts Technical developers
Similar to HL7 Implementation Guide CDC version State-specific, local versions
Sustainability Process Ensures long-term viability of the Logic Specification
and Test Cases
Features Project liaison to clarify ACIP Recommendations NIPInfo to address logic specification and testing aid inquiries Planned participation in ACIP working groups All materials available on the web with updated FAQs Regular communication and training opportunities related to
logic specification updates
“As-Is” ProcessCommunicationre “ACIP Recs”
ImplementersMake / Publish
Recs
Support Schedule Questions
· EHR· HIE
· IIS programs· IIS vendors
INDIVIDUAL INTERPRETATION of ACIP LOGIC
“To-Be” ProcessCommunicationre “ACIP Recs”
Communicationre “Logic Spec”
ImplementersLOGIC SPEC
TEST CASES
CDC IISSB
Update / Publish
Logic Spec
Make / Publish
Recs
Support Schedule / Logic Spec Questions
Communicationre “New Recs” and
“Logic Spec”
Challenges
Timely updates to the specification Expanding the specification to include currently
out-of-scope topics, such as the adult schedule Marketing and communication of resources to
potential users, particularly in the EHR community
Setting the expectations of potential users as to what the resources are
Continuing the liaison relationship and establishing one with ACIP
What’s Next?
Publication of Logic Specification – October 29th
Training Delivery – November 12th – 23rd
Introduction Supporting Data Tables Testing Aids
Support through [email protected]
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
Eric Larson – [email protected] Stuart Myerburg – [email protected] Wain – [email protected]
National Center for Immunization & Respiratory Diseases
Immunization Information Systems Support Branch
Project Contacts