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What is Evidence Based Medicine on FHIR?

EBMonFHIR is a standard for science data exchange

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Brian S. Alper, MD, MSPH, FAAFP, FAMIA, FGIN

® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

9/24/2024

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Our Team

Computable Publishing LLC

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Khalid Shahin

Senior Software Engineer

Christopher Enright

CIO

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Joanne Dehnbostel

Research & Analysis Manager

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Disclosure: Computable Publishing LLC owns the Fast Evidence Interoperability Resources (FEvIR) Platform.

Brian S. Alper

CEO

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Agenda

  • Creation of EBMonFHIR project
  • FHIR Resources – Evidence, EvidenceVariable, Citation, ArtifactAssessment
  • FEvIR Platform – tools to create EBMonFHIR Resources
  • ClinicalTrials.gov-to-FEvIR Converter
  • EBMonFHIR Implementation Guide
  • Getting Involved

® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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Creation of EBMonFHIR Project

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Produce guidance

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Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Produce evidence

Evaluate and improve practice

What are we creating?

Image adapted from MAGIC Evidence Ecosystem Foundation

Trustworthy

evidence

Coordination and

support

Common

Methodology

Culture for sharing and innovation

Tools

and

platforms

Digitally

structured

data

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Global standards

The Digital and Trustworthy

Evidence Ecosystem

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Produce guidance

Guidelines, Decision Aids, Clinical Decision Support

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Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Systematic Reviews

Produce evidence

Research Studies

Evaluate and improve practice

What are we creating?

Trustworthy

evidence

Coordination and

support

Common

Methodology

Culture for sharing and innovation

Tools

and

platforms

Digitally

structured

data

​

Global standards

The Digital and Trustworthy

Evidence Ecosystem

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Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Guidelines International Network GIN Tech Meeting-suggestion to achieve interoperability for Evidence Ecosystem

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2017

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Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Guidelines International Network GIN Tech Meeting-suggestion to achieve interoperability for Evidence Ecosystem

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2017

HL7 EBMonFHIR Project created-meetings 1x per week

2018

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Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Guidelines International Network GIN Tech Meeting-suggestion to achieve interoperability for Evidence Ecosystem

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2017

HL7 EBMonFHIR Project created-meetings 1x per week

2018

Covid-19 put pressure on the evidence system-Covid Knowledge Accelerator (COKA) - Meetings 10x per week

2020

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Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Guidelines International Network GIN Tech Meeting-suggestion to achieve interoperability for Evidence Ecosystem

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2017

HL7 EBMonFHIR Project created-meetings 1x per week

2018

Covid-19 put pressure on the evidence system-Covid Knowledge Accelerator (COKA) - Meetings 10x per week

2020

Scientific Knowledge Accelerator Foundation

Non-Profit created to support the effort.

2022

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Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Guidelines International Network GIN Tech Meeting-suggestion to achieve interoperability for Evidence Ecosystem

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2017

HL7 EBMonFHIR Project created-meetings 1x per week

2018

Covid-19 put pressure on the evidence system-Covid Knowledge Accelerator (COKA) - Meetings 10x per week

2020

Scientific Knowledge Accelerator Foundation

Non-Profit created to support the effort.

2022

COKA became Health Evidence Knowledge Accelerator (HEvKA) to widen our focus - 10-15 meetings/week

2023

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EBMonFHIR

Extending the Fast Healthcare Interoperability Resources (FHIR) standard for health data exchange to provide FHIR Resources for clinical research (evidence) and recommendations for clinical care (clinical practice guidance)

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Evidence Resource

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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Each variableDefinition instance:

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  • Has a variableRole code
    • e.g. population, exposure, outcome
  • May have observed Reference
    • (Group || EvidenceVariable)
  • May have intended Reference
    • (Group || EvidenceVariable)

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Evidence.statistic

  • statisticType (e.g. odds ratio) and attributeEstimate.type (e.g. p-value) are CodeableConcepts
  • numberAffected and sampleSize elements are unsignedInt values
  • modelCharacteristic can handle complex statistical models

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EvidenceVariable Resource

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EvidenceVariable.definition.reference

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Group used to define EvidenceVariable

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Citation Resource

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Why is Citation so complex?

  • Thousands of systems sharing citations.
  • Hundreds of ‘standards’ (loosely defined) for citation summaries
  • The most common ‘standard’ for citation data exchange (RIS) is not maintained and many systems have their own definitions of use replacing common elements
  • Citation indexes and reference management systems permeate science discovery and reporting.

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ArtifactAssessment Resource

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When to use ArtifactAssessment?

  • Comments
  • Ratings
  • Classifications
  • Risk of Bias Assessment
  • Guideline Panel Judgments for a Recommendation
  • Adaptation Report for content change (e.g. track changes)
  • Comparisons of Resource content

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FEvIR Platform�fevir.net�Fast Evidence Interoperability Resources

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ClinicalTrials.gov-to-FEvIR Converter

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EBMonFHIR Implementation Guide

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Evidence Profiles�

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  • EvidenceR6
    • SingleStudyEvidence
    • EvidenceSynthesisEvidence
    • NonComparativeEvidence
      • ComparatorOnlyEvidence
      • InterventionOnlyEvidence
      • BaselineMeasureEvidence
      • ParticipantFlowEvidence
    • ComparativeEvidence
      • ComparativeBaselineMeasureEvidence
      • ComparativeParticipantFlowEvidence
      • NetEffectContribution
    • EndpointAnalysisPlan
    • NetEffectEstimate

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EvidenceVariable Profiles�

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  • VariableDefinition
    • GroupAssignment
    • ParticipantFlowEvidenceVariable

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Group Profiles�

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  • GroupR6
    • CohortDefinition
      • StudyEligibilityCriteria
      • RecommendationEligibilityCriteria
      • SystematicReviewEligibilityCriteria
      • MetaanalysisEligibilityCriteria
      • SearchStrategy
      • ExposureDefinition
      • ComparatorDefinition
      • OutcomeDefinition
      • MetaanalysisOutcomeDefinition
      • EvidenceReportSubject
        • ComparativeEvidenceReportSubject
    • StudyGroup
    • ExposureGroup
    • ComparatorGroup
    • MetaanalysisStudyGroup
    • NetEffectContributions

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Citation Profiles�

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Getting Involved

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Fevir.net

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FHIR-focused meetings (4)

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Terminology-focused meetings (3)

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Tooling-focused meetings (4)

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Questions

  • balper@computablepublishing.com

  • fevir.net

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