EBMeDS and HL7 FHIRhl7.fi/wp-content/uploads/Duodecim-EBMeDS-FHIR... · EBMeDS and HL7 FHIR FHIR Application Roundtable, Kuntatalo, Helsinki 18.9.2017. EBMeDS an introduction. ...

EBMeDS and HL7 FHIRFHIR Application Roundtable, Kuntatalo, Helsinki 18.9.2017

EBMeDSan introduction

EBMeDS

• EBMeDS is a Clinical Decision Support System (CDSS)• matches individual patient data with evidence-based recommendations

(knowledge) that would benefit the patient

• provides actionable guidance automatically at the right time, in the right format at the right point in the workflow

• Integrated to all major EHR/EMR systems in Finland. Current coverage is over 50 % of doctors and nurses in public healthcare, and growing.

EBMeDS is automatic and integrated

• Embedded as part of EHR user interface

• Reminds and warns automatically of significant findings related to patient’s care. CDS takes into consideration• Age, gender, pregnancy, lactation and smoking status• Medication• Conditions• Laboratory results and physical measurements• Vaccinations• Procedures• ..and more

Example of generic reminders

Diabetes (E11.9)Coronary disease (I20.8)

BP: 145/90 mmHgPotassium: 6.1 mmol/l

EBMeDSUsing HL7 FHIR for Clinical Decision Support

Use of HL7 FHIR in EBMeDS

• HL7 FHIR has several characteristics that can benefit Clinical Decision Support• Internationally acknowledged

• Increasingly popular

• Less of data useless to CDSS (vs. CDA, HL7 v3)

• Two types of solutions are under development• CDS Hooks based (typically automatic) CDS service

• SMART on FHIR apps

CDS Hooks in short

• CDS Hooks are events in the professional’s or citizen’s workflow that trigger a query to the CDSS

• The CDSS returns cards that contain information, suggestions, links and possible actionable items (activityDefinition)

• Prefetch templates define what data is needed for each type of query, and boost performance

www.cds-hooks.org

CDS Hooks benefits

• Deeper integration with professional’s workflow

• Expected to become an international standard for CDSS• Potential to create a new ecosystem, where EHR client can choose to license

CDS Hooks from many different providers

• There is however some uncertainty about what will happen in STU4

• EBMeDS CDS Hook catalog is open for viewing https://ebmeds.github.io/api-gateway/

CDS Hooks – Focus on the workflow

Open patientrecord

Focus on a

diagnosis

Createlab order

Order drug

Renewprescripti

on

EBMeDS CDSS

CDS Hooks catalog

CDS Hooks example

Createlab order

Lab order x recommend

ed. Order now?

Adddiagnosis

EBMeDS CDSS

CDS Hook• new-diagnosis

CDS Card(s)• text• activityDefinition• etc.

Prefetch template• Observation• Condition• Medication• Etc.

ActivityDefinition(s)• Observation

carePlan

SMART on FHIR apps

• Initiated on-demand from the EHR

• Two demos implemented• Comprehensive Medication

Review

• Finrisk calculator

• Communication between the EHR and the app can be bidirectional

For more information

joonas.makinen [at] duodecim.fi

http://www.ebmeds.org