Stream: implementers
Topic: CDS rule definitions
James Bock (Apr 15 2020 at 15:23):
I’m trying to determine if it makes sense to store clinical decision support rule definitions for compounding software in FHIR.
Some rules are straightforward inside their patient population context:
Limit sodium intake to 10mEq per day
Others add complexity by including parameters of the patient:
Limit glucose intake to 12mg per kg per minute
Other rules depend on other components of the compounded order as a basis:
Include 1mmol Calcium per 1 mmol phosphorus.
The definition of PlanDefinition states it is “…general enough to support the description of a broad range of clinical artifacts such as clinical decision support rules, order sets and protocols.”, which makes me think this is the right resource to use but I’m uncertain on how I would execute it.
There are so many resources that, to me, seem like they could be molded to my use-case but I’m having difficulty decisively nailing down the implementation.
Any advice would be greatly appreciated.
Lloyd McKenzie (Apr 15 2020 at 15:28):
@Bryn Rhodes
Bryn Rhodes (Apr 16 2020 at 19:38):
@James Bock , apologies for the delay. Yes, there is guidance in the base specification in the Clinical Reasoning, as well as an in progress implementation guide for using resources like PlanDefinition to express this type of content, CPG-on-FHIR, and there's an example content IG that conforms to that guidance, the Opioid Prescribing Guidelines. There's also a group that meets bi-weekly to work on this type of content: call.
James Bock (Apr 16 2020 at 21:32):
Bryn Rhodes said:
James Bock , apologies for the delay. Yes, there is guidance in the base specification in the Clinical Reasoning, as well as an in progress implementation guide for using resources like PlanDefinition to express this type of content, CPG-on-FHIR, and there's an example content IG that conforms to that guidance, the Opioid Prescribing Guidelines. There's also a group that meets bi-weekly to work on this type of content: call.
This is useful. Thanks, Bryn! Looking at the example below, specifically:
http://build.fhir.org/ig/HL7/cqf-recommendations/PlanDefinition-va-ckd-recommendations.html
For my purposes, the resource boils down to a patient population specific recommendation for a protein intake of 0.6 to 0.8 g/kg/day. Would it be appropriate to add an extension that slices or granularizes this portion of the resource by using a Substance or Medication to represent protein, a group to represent the patient population (CKD 3 or 4) and a dosage to represent the range? I would also need a way to reference a patient for the weight basis.
The current system uses objects like those described above to evaluate different recommendations that target the same factor (i.e. protein intake) a determines if any of them take precedence in the real-time context. Given that all the patient and prescription information is FHIR, it would be nice to not have to store the CDS rules in a separate database.
Last updated: Apr 12 2022 at 19:14 UTC
