Supporting Clinical Decision Support using CDS Hooks

Abstract

The World Health Organization (WHO) has been working on a framework for translating guidelines into executable clinical decision support (CDS) into digital systems. One of the goals of this is to provide computable content along with a clinical decision support engine to enable CDS to be implemented and used locally within Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems, such as OpenMRS. This is being developed using 

One of the gaps is how an application like OpenMRS would trigger and ingest these CDS services, and display notifications to end-users.

One such solution to this is CDS Hooks, which provides a specification that enables integration of remote decision support within a clinician's EHR/EMR workflow through a "hook"-based pattern. It describes a "hook"-based pattern for invoking decision support from within a clinician's workflow. The API supports:

• Synchronous, workflow-triggered CDS calls returning information and suggestions
• Launching a user-facing SMART app when CDS requires additional interaction

The aim of this project is to develop a proof of concept to show how CDS Hooks could be leveraged in OpenMRS to support triggering and ingesting CDS services, and displaying CDS notifications and content to end-users.

Project Champions

Daniel Futerman, Bryn Rhodes, Natschja Ratanaprayul

Goals

• Develop a proof of concept to show how CDS Hooks could be leveraged in OpenMRS. This will be acheived by:
• Adapting and running this CDS Services Tutorial with the CDS Hooks sandbox switched out for OpenMRS, to:
  
  • Show how a CDS hook can be triggered in OpenMRS.
  • Try to leverage one of the WHO computable guideline examples and sandbox engine (see here) as the CDS service.
  • Show how OpenMRS is able to consume and render a CDS card in response to the hook.

Expected Deliverables

• TBD

Sounds cool. How can you get started?

• Get familiar with development best practices in OpenMRS
• Get to grips with the basic CDS concepts,
• Read up on CDS Hooks
• Run through the WHO Antenatal Care Guideline Quick Start and sandbox infrastructure,
• Run through the Cerner CDS Services Tutorial, and consider how you may go about switching out the CDS Hooks sandbox in this tutorial with a tool like OpenMRS.

Requirements

• Good Java and React skills.
• Soft skills to interact with the WHO Computable Care Guidelines and FHIR communities in order to gather requirements and technical feedback.
• Familiarity or willingness to learn basics of HL7 FHIR, SMART.

Resources

CDS Hooks - https://cds-hooks.org/

Computable Care Guidelines profile - https://wiki.ihe.net/index.php/Computable_Care_Guidelines

CDS Services Tutorial - https://github.com/cerner/cds-services-tutorial/wiki

HL7 FHIR Clinical Guidelines - http://hl7.org/fhir/uv/cpg/2019Sep/

WHO Clinical Guidelines Presentation - https://drive.google.com/file/d/1OoOn3gnPhsDPdV8oBb9niV0tkfX1WbR4/view

WHO Antenatal Care Guideline Quick Start - http://build.fhir.org/ig/who-int/anc-cds/quick-start.html

A multi-layered framework for disseminating knowledge for computer-based decision support - https://academic.oup.com/jamia/article/18/Supplement_1/i132/797073