FHIR Chat · September 2019 Connectathon

Stream: cds hooks

Topic: September 2019 Connectathon

Dennis Patterson (Aug 07 2019 at 20:09):

Hi everyone!

The next HL7 FHIR Connectathon is rapidly approaching! It'll be held on September 14-15 (Saturday & Sunday) at the Atlanta Marriott Marquis in Atlanta, GA.

If you haven't taken a look already, please check out the track page which includes scenarios for implementing the 1.0 spec as well as Argonaut scenarios for implementing PAMA use-cases.

Outside of existing Argonaut calls, we'll be having a Connectathon Track Orientation on Wednesday, September 4th at 2pm Central (details again on the track page linked above).

Let me know if you have any questions. Looking forward to seeing everybody in Atlanta!

Isaac Vetter (Aug 09 2019 at 16:29):

Hey Guys! From today's CDS Hooks argonaut call, it sounds like there won't be many CDS Hooks services participating. Is this true? Mind speaking up if you're planning on participating in person or remotely in the CDS Hooks track in Sept?

Lloyd McKenzie (Aug 09 2019 at 16:33):

There should be some folks from Da Vinci testing CDS hooks from a payer perspective that could act as services, though don't know specific numbers yet.

Lloyd McKenzie (Aug 09 2019 at 16:33):

They'd be signed up to the "prior authorization" track where CRD is one part of the track.

Josh Mandel (Aug 10 2019 at 18:08):

(Specifically re: Argonaut call, the question is about clients participating for the PAMA scenarios, which test things like systemActions that return a rating for an order; and SMART apps that can adjust orders via web messaging.)

Dennis Patterson (Aug 29 2019 at 14:39):

Reminder that we'll be having Connectathon Track Orientation on Wednesday, September 4th at 2pm Central, as noted on the track details page!

Also, if you haven't filled out the Pre-Connectathon survey, please do so to indicate your interest in the track and help out the organizers.

Dennis Patterson (Sep 04 2019 at 20:59):

The track details page has been updated with orientation slides and a link to a recording if you weren't able to make it.

Reminder again to fill out the Pre-Connectathon survey, which helps ensure we have an adequate number of tables. Also, please indicate your interest in this specific track by updating this document with who you represent, targeted hooks, what you hope to get out of the connectathon, etc.

Lastly, note that we're planning 2 breakout sessions on Sunday at the Connectathon. The first will be at 11am to assess track progress, discuss issues, etc. The second will be at 3:30pm to discuss/plan what's next with version 1.1 of the spec

Steve Millard (Sep 09 2019 at 15:05):

The FDB service endpoints are now available for testing. We support patient-view, order-select and order sign for DSTU2, STU3 and R4 FHIR versions. Endpoints have been updated on the participant tracking spreadsheet. We will display suggestion cards for the removal of medications in the order-sign / order-select. An app link card will also be displayed for all hooks.

Patient view hook medications for Hyperkalemia screen:
Lisinopril 20mg every day
Spironolactone 25mg every day
Potassium Chloride 20meq every day

Order select/order sign medications for Pharmacogenomics screen:
abacavir 300mg every day

Order select/order sign medications for Opioid Risk Assessment screen:
Fentanyl 75mcg patch q72hr
Oxycodone 5 mg every 4 hours as needed
Cyclobenzaprine 10mg every 8 hours as needed
Alprazolam 2.5mg every 8 hours as needed

Please contact me to set up your jwks

Kol Kheang (Sep 09 2019 at 15:26):

@Steve Millard We will call your services some time today to try them out.

Dennis Patterson (Sep 14 2019 at 13:04):

Good Morning! Shortly after someone kicks off the connectathon event, we'll grab a corner or go out in the hall and kick off our track. This will give everybody a chance to put names/orgs with faces, see who has brought a client vs a server, and jump start our track

Dennis Patterson (Sep 14 2019 at 13:05):

If you haven't already, please make sure you've added yourself out on https://bit.ly/cds-hooks-connectathon-tracking

Dennis Patterson (Sep 14 2019 at 13:39):

After the kick-off, if you're wondering what PAMA is and why we're talking about it so much, I invite you to go and check out https://github.com/argonautproject/cds-hooks-for-pama/blob/master/guidance.md

Dennis Patterson (Sep 14 2019 at 13:54):

To re-iterate the breakout schedule, we will have 2 tomorrow. The first will be at 11am to assess track progress, discuss issues, etc. The second will be at 3:30pm to discuss/plan what's next with version 1.1 of the spec. Both will be in Room M 106 & 107

Chuck Feltner (Sep 14 2019 at 15:41):

Good Morning! Any CDS Services at the Connectathon supporting the Argonaut PAMA Scenarios 1 or 3? Would like to test it out with our EHR.

Dennis Patterson (Sep 14 2019 at 16:05):

Hi Chuck! I think your best bet will be to start with the service used by the sandbox - https://fhir-org-cds-services.appspot.com/cds-services/pama-imaging . It is set up for all three pama scenarios

Dennis Patterson (Sep 14 2019 at 16:06):

Also FYI @Raj M with Wolters Kluwer is looking to try out SMART Web Messaging, but not in the context of pama

Chuck Feltner (Sep 14 2019 at 16:10):

Ok great thanks @Dennis Patterson . Will try testing out with that test service.

Raj M (Sep 14 2019 at 17:45):

Also FYI Raj M with Wolters Kluwer is looking to try out SMART Web Messaging, but not in the context of pama

@Chuck Feltner checkout the smart-message-mock-order-evaluate hook @ https://prototypes.utdlab.com/argonaut/cds-services

Julie Winters (Sep 14 2019 at 18:07):

@Chuck Feltner, if you are wanting to test a CDS Service that is different than the sandbox service I just published a service that should be complete for PAMA scenario 1. https://mayo-cds-hooks-connectathon-22.azurewebsites.net/cds-services

Chuck Feltner (Sep 14 2019 at 18:25):

Thanks @Julie Winters , I will try it out.

Dennis Patterson (Sep 15 2019 at 13:36):

Good morning! I have a breakout room schedule update. We've decided to consolidate to one session and start slightly earlier. So, consider the first breakout at 11 canceled and we'll meet in Room M 106 & 107 at 3pm

Dennis Patterson (Sep 15 2019 at 14:18):

If you haven't already responded to my e-mail, please send me a few sentences (via private message or e-mail at dennis.patterson@cerner.com) before lunch covering connectathon progress such as...

Who you integrated with
What you tested/accomplished/uncovered
Any CDS Service screenshots (from the public sandbox or in the context of another CDS Client / EHR)
Anything else you’d like to share

Dennis Patterson (Sep 15 2019 at 18:00):

Initial Connectathon report out is available out on https://docs.google.com/document/d/1WNYWLEf28j8DPyDachC8jpk-QbkyuPxP/edit#heading=h.1t3h5sf . Please reach out to me if you have any corrections/additions that you'd like to see included!

Dennis Patterson (Sep 15 2019 at 18:50):

Breakout session coming up in 10 minutes!

Dennis Patterson (Sep 15 2019 at 18:59):

Heading over to the breakout room

Josh Mandel (Sep 15 2019 at 19:46):

I'll capture notes from breakout here (unattributed; we have ~30 folks in the discussion).

Discussion: override reasons.

Josh Mandel (Sep 15 2019 at 19:47):

There are examples of clinician actions that dismiss a card that aren't really "overriding" (e.g., "I'm asking my colleague to address this")

Is there a difference between existing suggestions capability (with a notice --> feedback service when selected) vs "override reasons" (which also would have a notice --> feedback service when selected) ?

Josh Mandel (Sep 15 2019 at 19:50):

Often a decision to "snooze" a card should come with a reason/explanation (e.g., patient is on chemotherapy right now).

Josh Mandel (Sep 15 2019 at 19:50):

There are lots of options, re: defining a catalog of responses. Should they be standardized?

Josh Mandel (Sep 15 2019 at 19:51):

Is it possible to capture the "override reason", for example in a FHIR resource that the EHR will keep?

Josh Mandel (Sep 15 2019 at 19:53):

e.g. if a patient declines colonoscopy because it's too expensive. It'd be nice to make this known to future services, too (?).

Josh Mandel (Sep 15 2019 at 19:56):

The CDS Service might be able to generate a list of common refusal reasons (e.g., patient preference; cost; contraindication; etc).

Josh Mandel (Sep 15 2019 at 19:58):

Alternatively, the EHR might understand suggestions (e.g., through tags/codings) well enough to remember reasons over time and suppress future cards.

Josh Mandel (Sep 15 2019 at 19:59):

Can we separate concerns?

Services focused on providing decision logic (e.g., the rules about when colonoscopy is appropriate)
Pedigree of events, like which suggestions were received, declined, etc