Coordinated use of Health Level 7 standards to support clinical decision support: Case study with shared decision making and drug-drug interactions.
Coordinated use of Health Level 7 standards to support clinical decision support: Case study with shared decision making and drug-drug interactions.
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DOI：
10.1016/j.ijmedinf.2022.104749
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发表时间：
2022-03-21
影响因子：
4.9
通讯作者：
Reese, Thomas
中科院分区：
文献类型：
--
作者：
Thiess, Henrik;Del Fiol, Guilherme;Malone, Daniel C.;Cornia, Ryan;Sibilla, Max;Rhodes, Bryn;Boyce, Richard D.;Kawamoto, Kensaku;Reese, Thomas
关键词：
尽管互操作性标准取得了进展，但在医疗保健组织之间共享临床决策支持（CDS）仍然具有挑战性，而且通常成本高昂。这部分是由于CDS各组成部分之间的协调有限。为了提高CDS组件的协调性，HL 7（Health Level 7）开发了一套互操作性标准，并将快速健康互操作性资源（Fast Health Interoperability Resources，FHIR）规范作为公共信息模型。需要证据来确定实施这些CDS组件的可行性;因此，本研究的目的是调查新兴的HL 7标准与模块化CDS架构组件的协调。我们使用了一个模块化的、基于标准的体系结构，它由四个组件组成：数据、逻辑、服务和应用程序。实施用例是支持药物相互作用背景下共同决策的应用程序（DDInteract）。DDInteract使用FHIR作为数据表示模型，临床质量语言用于逻辑表示，CDS Hooks用于服务层，可替代医疗应用程序可重用技术用于应用程序集成。DDInteract首先在沙箱环境中实现，然后在电子健康记录（Epic®）测试环境中实现。DDInteract可以通过菜单中的按需访问或打开患者记录或下药物订单时通过CDS Hooks集成到临床工作流程中。在药物相互作用的背景下，DDInteract是第一个利用模块化CDS架构的每个组件的新兴互操作性标准的完整堆栈的应用程序。可互操作组件的可行性可以推广到其他模块化CDS应用。
Despite advances in interoperability standards, it remains challenging and often costly to share clinical decision support (CDS) across healthcare organizations. This is due in part to limited coordination among CDS components. To improve coordination of CDS components, Health Level 7 (HL7) has developed a suite of interoperability standards with Fast Health Interoperability Resources (FHIR) specification as a common information model. Evidence is needed to determine the feasibility of implementing these CDS components; therefore, the objective of this study was to investigate the coordination of emerging HL7 standards with modular CDS architecture components. We used a modular, standards-based architecture consisting of four components: data, logic, services, and applications. The implementation use-case was an application to support shared decision making in the context of drug-drug interactions (DDInteract). DDInteract uses FHIR as the data representation model, Clinical Quality Language for logic representation, CDS Hooks for the services layer, and Substitutable Medical Apps Reusable Technologies for application integration. DDInteract was first implemented in a sandbox environment and then in an electronic health record (Epic®) test environment. DDInteract can be integrated in clinical workflows through on-demand access from a menu or through CDS Hooks upon opening a patient’s record or placing a medication order. In the context of drug interactions, DDInteract is the first application to leverage a full stack of emerging interoperability standards for each component of modular CDS architecture. The demonstrated feasibility of interoperable components can be generalized to other modular CDS applications.
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影响因子：
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作者：
Bouaud, J;Lamy, J-B
通讯作者：
Lamy, J-B
DOI：
10.1007/bf01133012
发表时间：
1993-11-01
期刊：
INTERNATIONAL JOURNAL OF CLINICAL MONITORING AND COMPUTING
影响因子：
--
作者：
PRYOR, TA;HRIPCSAK, G
通讯作者：
HRIPCSAK, G
影响因子：
5.3
作者：
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通讯作者：
Huser V
影响因子：
3.2
作者：
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通讯作者：
Khorasani, Ramin
DOI：
10.1093/jamia/ocv189
发表时间：
2016-09
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Mandel JC;Kreda DA;Mandl KD;Kohane IS;Ramoni RB
通讯作者：
Ramoni RB