Summary:
OpenMRS needs a solution for:
(1) a CDS Engine,
(2) Authoring that's Clinician-friendly,
(3) a way to test rules, and;
(4) sources of content that are trustworthy, free, and actively maintained.
Contents:
1. Problem
A Recipe for CDS
CDS is a massive topical field. It helps to think about it as a “Recipe” with some key “Ingredients” (components). We need a solution for each of these.
A Recipe for CDS | ||
---|---|---|
Ingredient | Notes | How we plan to solve this |
🧠 Brain / CDS Engine | Examples include:
| Drools |
Authoring that’s Clinician- and BA-Friendly | BA-friendly way to represent and write rules, content Way to safely QA / review rules that is Clinician- or BA-friendly. | DMN (graph/chart), BPMN (), decision tables |
Way to test rules | This is usually overlooked. | |
Content | Examples include:
| GAP. Need to find: Are there public datasets out there? |
2. User Stories
3. Market Analysis
Helpful links & resources from previous CDS initiatives:
CDS-related Roadmap Items: https://openmrs.atlassian.net/jira/polaris/projects/OMRS/ideas/view/6314977
SMART Guidelines & CQL (Clinical Quality Language):
Docs about what we set up: Implementing SMART Guideline Indicators and CDS in OpenMRS
Sample ANC Maternity CDS rules in spreadsheet format: https://docs.google.com/spreadsheets/d/1lRXhJg7JQboYl9sGif8Tslc3HYK17jG2/edit?gid=206805698#gid=206805698
Sample HIV CDS rules in spreadsheet format: https://docs.google.com/spreadsheets/d/117bKXdJ1GnAuQgR5JdftFOlPY7EOpTZT/edit?gid=1103435742#gid=1103435742
Miro: Brainstorming / mind-map about CDS for OpenMRS, and notes from CDS session in 2024: https://miro.com/app/board/uXjVKcNhIQ8=/
Talk: O3 & CDS: A way forward for Clinical Decision Support must-haves https://talk.openmrs.org/t/o3-cds-a-way-forward-for-clinical-decision-support-must-haves/43089
Learning from Bahmni’s CDS efforts & SNOMED CT project:
CDSS alert notification in Bahmni for drug-diagnosis interaction using SNOMED CT https://www.youtube.com/watch?v=P7BRsMra6_M&ab_channel=BahmniCommunity
Bahmni CDSS Demo and E2E automation testing https://www.youtube.com/watch?v=PAkgaq6Qjuk&ab_channel=BahmniCommunity
Old CDS hooks initiative: Supporting Clinical Decision Support using CDS Hooks
CDS-related UI Design Patterns:
Flags : https://zeroheight.com/23a080e38/p/851fea-patient-flags
Tasks (vision is that some tasks are generated automatically based on certain criteria): https://zeroheight.com/23a080e38/p/6226bc-task-management
Orders (specifically, showing allergies at the point of ordering): https://zeroheight.com/23a080e38/p/71ad91-order-basket
Clinical Views (showing just what you think a clinician would want to know is technically a form of CDS, even if it’s static / manual-config-driven): https://zeroheight.com/23a080e38/p/77d3d3-clinical-views
OpenMRS NoviGuide Module Demo.mov https://drive.google.com/file/d/1i3oTZIRu81sExDp8Qf_K7e6Ygx2l1gOr/view
SMART Guidelines & CQL “101”
Explaining our approach to SMART Guidelines & CQL Engine in 2023.
SMART Guidelines & CQL (Clinical Quality Language):
Analysis of Categories of ANC WHO CDS Rules https://docs.google.com/spreadsheets/d/14sTL6D7ZcuYPMJ3IkBRgpWFTDk2x6EU9LhcKosOynn4/edit?gid=0#gid=0
Docs about what we set up: Implementing SMART Guideline Indicators and CDS in OpenMRS
Sample ANC Maternity CDS rules in spreadsheet format: https://docs.google.com/spreadsheets/d/1lRXhJg7JQboYl9sGif8Tslc3HYK17jG2/edit?gid=206805698#gid=206805698
Sample HIV CDS rules in spreadsheet format: https://docs.google.com/spreadsheets/d/117bKXdJ1GnAuQgR5JdftFOlPY7EOpTZT/edit?gid=1103435742#gid=1103435742
4. Technical Considerations & Dependencies
5. QA Plan:
TBC: The plan for QA, such as how we will discover and address edge cases
TBC: Plan for automated tests to be added to new components (unit tests) or workflows (e2e tests)
6. Safety & Tech Risks
TBC: Is there any reason you could regret rolling out this feature? (e.g. possible patient harm, heavy tech debt like introducing an unsupported library)
TBC: Have you thought through the risks for this particular solution? And, how to reduce/address those?