Jeremy J Michel1,2, Emilia J Flores3, Lauren Dutcher4,5, Nikhil K Mull3,6, Amy Y Tsou1,7. 1. Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, ECRI, Plymouth Meeting, Pennsylvania, USA. 2. Department of Biomedical and Healthcare Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 3. Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA. 4. Division of Infectious Diseases, Department of Medicine. 5. Department of Biostatistics, Epidemiology, and Informatics. 6. Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 7. Division of Neurology, Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVE: To develop a process for translating semi-structured clinical decision support (CDS) into shareable, computer-readable CDS. MATERIALS AND METHODS: We developed a systematic and transparent process using publicly available tools (eGLIA, GEM Cutter, VSAC, and the CDS Authoring Tool) to translate an evidence-based clinical pathway (CP) into a Clinical Quality Language (CQL)-encoded CDS artifact. RESULTS: We produced a 4-phase process for translating a CP into a CQL-based CDS artifact. CP content was extracted using GEM into discrete clinical concepts, encoded using standard terminologies into value sets on VSAC, evaluated against workflows using a wireframe, and finally structured as a computer readable CDS artifact using CQL. This process included a quality control step and intermediate products to support transparency and reuse by other CDS developers. DISCUSSION: Translating a CP into a shareable, computer-readable CDS artifact was accomplished through a systematic process. Our process identified areas of ambiguity and gaps in the CP, which generated improvements in the CP. Collaboration with clinical subject experts and the CP development team was essential for translation. Publicly available tools were sufficient to support most translation steps, but expression of certain complex concepts required manual encoding. CONCLUSION: Standardized development of CDS from a CP is feasible using a systematic 4-phase process. CPs represent a potential reservoir for developers of evidence-based CDS. Aspects of CP development simplified portions of the CDS translation process. Publicly available tools can facilitate CDS development; however, enhanced tool features are needed to model complex CDS statements.
OBJECTIVE: To develop a process for translating semi-structured clinical decision support (CDS) into shareable, computer-readable CDS. MATERIALS AND METHODS: We developed a systematic and transparent process using publicly available tools (eGLIA, GEM Cutter, VSAC, and the CDS Authoring Tool) to translate an evidence-based clinical pathway (CP) into a Clinical Quality Language (CQL)-encoded CDS artifact. RESULTS: We produced a 4-phase process for translating a CP into a CQL-based CDS artifact. CP content was extracted using GEM into discrete clinical concepts, encoded using standard terminologies into value sets on VSAC, evaluated against workflows using a wireframe, and finally structured as a computer readable CDS artifact using CQL. This process included a quality control step and intermediate products to support transparency and reuse by other CDS developers. DISCUSSION: Translating a CP into a shareable, computer-readable CDS artifact was accomplished through a systematic process. Our process identified areas of ambiguity and gaps in the CP, which generated improvements in the CP. Collaboration with clinical subject experts and the CP development team was essential for translation. Publicly available tools were sufficient to support most translation steps, but expression of certain complex concepts required manual encoding. CONCLUSION: Standardized development of CDS from a CP is feasible using a systematic 4-phase process. CPs represent a potential reservoir for developers of evidence-based CDS. Aspects of CP development simplified portions of the CDS translation process. Publicly available tools can facilitate CDS development; however, enhanced tool features are needed to model complex CDS statements.
Authors: Evan W Orenstein; Katherine Yun; Clara Warden; Michael J Westerhaus; Morgan G Mirth; Dean Karavite; Blain Mamo; Kavya Sundar; Jeremy J Michel Journal: J Am Med Inform Assoc Date: 2019-12-01 Impact factor: 4.497
Authors: Joan S Ash; Dean F Sittig; Richard Dykstra; Adam Wright; Carmit McMullen; Joshua Richardson; Blackford Middleton Journal: Stud Health Technol Inform Date: 2010
Authors: Joshua C Mandel; David A Kreda; Kenneth D Mandl; Isaac S Kohane; Rachel B Ramoni Journal: J Am Med Inform Assoc Date: 2016-02-17 Impact factor: 4.497
Authors: Stijn Van de Velde; Ilkka Kunnamo; Pavel Roshanov; Tiina Kortteisto; Bert Aertgeerts; Per Olav Vandvik; Signe Flottorp Journal: Implement Sci Date: 2018-06-25 Impact factor: 7.327