HL7 Clinical Guidelines Special
Interest Group
Meeting Minutes
Spring Working Group Meeting,
Author: Robert
Greenes
Attendance: Robert Abarbanel (IDX;
robert_abarbanel@idx.com), Jim Campbell (University of Nebraska;
campbell@unmc.edu), Brett Esler (PEN Computer Systems; brett@pencs.com.au),
Joachim Dudek (HL7 Germany; jwd@uni-giessen.de), Bob Greenes (Partners
Healthcare; greenes@harvard.edu), Tom Hooks (McKesson; tom.hooks@mckesson.com),
Thomson Kuhn (ACP-ASIM; tkuhn@mail.acponline.org), Vince McCauley (HL7
Australia; vincem@mccauleysoftware.com), Rob McClure (MD Partners;
rob.mcclure@mdpartners.com), Craig Parker (IHC; craig.parker@ihc.com), Ian
Purves (SCHIN; ian.purves@ncl.ac.uk), David Rowed
(HL7 Australia; drowed@bigpond.net.au), Sarah Ryan (NASA;
sarah.a.ryan1@jsc.nasa.gov), Samson Tu
(Stanford U; tu@smi.stanford.edu), Dongwen Wang (Columbia U;
dongwen.wang@dmi.columbia.edu), Bob Badgett (U of Texas Health Science Center
San Antonio; Badgett@uthscsa.edu), Howard Strasberg (Walter Kluwer Health;
howard@skolar.com), Richard Franck (IBM; Richard.franck@us.ibm.com), Matt
Sailors (U Texas at Houston; matthew.sailors@uth.tmc.edu), Dan Rossler
(McKesson; dan.rossler@mckesson.com), Judy Warren (U of Kansas;
jwarren2@kumc.edu), William Goossen (Acquent R&D; williamtfgoosen@cs.com).
Quarter
1
Decision-making
procedures of SIG
The procedures adopted
by the parent TC (Clinical Decision Support) were proposed as the basis for
this SIG’s procedures without modification. This was passed unanimously.
SAGE update (Bob Abarbanel presentation)
Project extended to
middle of ’05 through no-cost extension granted by NIST.
Overview of guideline
(GL) development, SAGE components, and mode of deployment presented.
Relies on CTS standard
being balloted (a number of participants are supported by SAGE).
Sharability through CD
containing GL metadata, executable logic, readable logic, test data,
installation data and scripts, and tools for tailoring the GL.
Discussion: Sharability:
Public domain except where interfaces with IDX system.
Report of
Samson Tu attended the
meeting in April 2004 and provided an overview.
Book of proceedings now available, Computer-based
Support for Clinical Guidelines and Protocols,
Order set update (Jim
Campbell presentation)
Issues of logic,
indication/problem indexing, strength of recommendation, prioritization,
presentation layer.
Proposal for a
functional convergence model: publication/maintenance, localization of content, presentation and clinical use,
interoperation of decision support, and a structural convergence model with
header and body sections.
Action items: Cambpell
to lead, del Fiol, IHC team, to have draft report by end of July.
Distribute draft copy of scope, convergent model,
use cases.
Preliminary surveys
User community:
check for relevant activity in Orders and Obserations
TC
Vendor survey
CPGA comments and
convergence
Telephone conferencing
McClure: Should check with G-I-N
Quarter 2
VMR update (Craig Parker)
Status of VMR effort to date:
conference calls and development of consensus data mode (API later)
Assembling a collection
of use cases (Tu is point person).
Lab value out of range
alert as simple use case to define a simple VMR (using HL7 V3).
Enhance VMR
incrementally for successive use cases.
Issues: Which R-MIMs to use (see next topic), HDF
methodology compliance documents in process.
Patient-care DIM (Dan
Rossler, William Goossen)
Care Provision Domain
Information Model (CP DIM) -- consider all the info need to convey if transferring
care from one person to another.
Note that querying a VMR
is querying a DIM not an RMIM (RMIMs correspond to messages).
Tu asked how to query
this DIM. Answer is that this has not
been worked out and that CQ will need to provide technical help.
Rossler: Oracle is building v.3 DB which can map v.2
messages to the DB. CDC NEDDS and QuadraMed DBs are doing similar things.
Action items:
Rossler: Draft of above to come out in July, comments by the CDS TC/CG
SIG are sought.
Parker: To interact with Patient Care TC to develop
use cases to evaluate this model before the July draft, Tu is collecting use
cases.
TC/SIG
participants can follow discussions also via the PC TC mailing list.
DMIM for this discussion
to be found on minutes of Patient Care TC for this WG meeting.
CPGA update (Ian
Purves)
CPG is accepted as a
reference architecture (CPG-RA) for the G-I-N project, Purves to lead a
standardization effort. Goal to develop
use cases for it. See http://www,cpg-ra.net.
PRODIGY update (Purves presentation)
Prodigy Release 2 aims
to support matching of individual learning styles: condition pathways which propose decisions and
actions while in consultation, alert and reminder services, review of existing
medications while prescribing, and browsing of guidance narratives.
NHS National Programme
for IT (NPfIT – 850M for central spine and 1.3B for each of 5 regions).
Guideline model
standard strategy (Ed Hammond)
Funding for CDS now
possible through many sources, IOM AHRQ NHII HHS focus on EHR, NLM vocabulary
sole source initiative, AHRQ standards acceleration, VA, congressional
initiatives.
Needs clear articulation
of CDS needs and what’s different now, given the multiple failed efforts
to date to create national scale effort.
Geesson: Dutch office
running project with vendors as consultants.
Quarter 3
Decision support
priorities (Tu, Greenes)
Given the new momentum
for healthcare IT, important to identify short-term high-impact items to focus
on.
Kuhn: participate in HIMSS IHE demo, e.g., order-set
functionality. McClure: possibility of funding for evaluation of
impact of this demo on degree of sharing, and ease of moving proven order sets
into implementations.
Action items:
Possibility of an
end-to-end demo of guidelines going from markup to computable form to execution
discussed. Matt Sailors to propose a
project for evaluation of existing markup tools.
Quarter 4
No business
Agenda for Atlanta Meeting (27 September - 1 October 2004)
TBD
Requested meeting day: Thursday, 30 September 2004 0900-1700.