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FHIR Connectathon 27

Evidence-Based Medicine/COVID-19 Knowledge Accelerator Track Highlights

Brian Alper: balper@computablepublishing.com

© 2019+ Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

2021-05-19

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Agenda

EBMonFHIR Introduction
COVID-19 Knowledge Accelerator Introduction
EBM/COKA related Resources and Tools
FHIR Connectathon Track Goals
FHIR Connectathon Track Achievements
Questions/Next Steps

© 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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EBM-ON-FHIR INTRODUCTION

© 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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FHIR IS MAKING HEALTH DATA FAIR

Fast Healthcare Interoperability Resources (FHIR) is an HL7 standard for electronic data exchange
FHIR enables data to be Findable, Accessible, Interoperable and Reusable (FAIR)
FHIR solves long-intractable problems of sharing health data
Resources (the R in FHIR) is the technical HOW
HL7 standards development process is the human HOW

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Evidence-Based Medicine wants to be FAIR

Evidence-based medicine (EBM) is

“the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”
“integration of clinical expertise, patient’s values and best available evidence in process of decision making related to patients health care”
“integration of best research evidence with clinical expertise and patient values”

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Evidence = Analyzed Data

Evidence = Data + Context
Evidence is often published in journals
Data in FHIR + Context in journals does not interoperate

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Evidence

Data

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Evidence to Guidance to Action

Evidence is often published in journals
Guidance is often in decision support tools
Action can be in FHIR – but do these things interoperate?

© 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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Evidence

Data

Guidance

Action

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The Health Knowledge Flow we want

Data Analysis, Synthesis, and Interpretation.

EVIDENCE

Guidelines, Recommendations, Decision Aids, Decision Support

GUIDANCE

Observations and Measurements.

DATA

Healthcare (testing and intervention) decision-making and implementation

ACTION

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EBMonFHIR extends FHIR to EBM data

FHIR Resources for Evidence-Based Medicine (EBM) Knowledge Assets project (EBMonFHIR) started 2018.
Goal: provide interoperability for clinical research (evidence) and recommendations for clinical care

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EBMonFHIR extends FHIR to EBM data

EBMonFHIR sponsored by 3 HL7 Work Groups

Clinical Decision Support (CDS)
Clinical Quality Information (CQI)
Biomedical Research and Regulation (BRR)

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COVID-19 KNOWLEDGE ACCELERATOR INTRODUCTION

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COVID-19 Knowledge Accelerator (COKA)

A virtual organization – no cost, no contracts
Open, transparent – all meetings
Engages multiple global collaborative groups, organizations, and individuals
A way for any to volunteer to accelerate development and implementation of standards for evidence exchange, especially with attention to COVID-19

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COKA has 10-12 active working groups

Project Management
Terminology and Ontology WG
Research Design WG
Statistic Standard and Terminology WG
Risk of Bias Terminology and Tooling WG
Common Metadata Framework WG (+ Expansion WG)
Content Citation and Classification Tools Development WG
Systematic Meta-Review Project Group (+ Supplemental WG)
Knowledge Ecosystem Liaison WG
Communications WG

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COKA: How to Participate

For all of these meetings: Join Microsoft Teams Meeting
If you wish to learn more about COKA please go to Tinyurl.com/coka2020
Questions: balper@computablepublishing.com

Day	Time (Eastern)	Team
Monday	7-8 am	Project Management
Monday	9-10 am	Systematic Meta-Review Project Group
Monday	11 am-12 pm	Systematic Meta-Review Project Group Supplemental
Monday	1-2 pm	Terminology and Ontology WG
Tuesday	10-11 am	Common Metadata Framework WG
Tuesday	11 am-12 pm	Common Metadata Framework WG Expansion
Tuesday	2-3 pm	Research Design WG
Wednesday	8-9 am	Knowledge Ecosystem Liaison WG
Wednesday	9-10 am	Statistic Standard and Terminology WG
Thursday	9-10 am	Content Citation and Classification Tools Development
Thursday	4-5 pm	Project Management
Friday	9-10 am	Risk of Bias Terminology and Tooling WG
Friday	10-11 am	Communications (Awareness, Scholarly Publications)

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EBM/COKA RELATED RESOURCES AND TOOLS

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COKA Activities – all 4 components

Contextualized application for each instance

Specific content and people

Common format for how data elements are expressed

Schema

Common interfaces (UIs and APIs) and data transformations

Tooling

Common vocabulary and code systems

Terminology

FHIR Citation Resource
FHIR EvidenceReport Resource
FHIR Evidence Resource

FHIR EvidenceVariable Resource
FHIR Group Resource
FHIR Statistic Resource [Datatype]

Study Design Code System
Statistic Code System

Statistic Type Code System

Statistic Model Code System
Certainty Code System
Risk of Bias Code System

Citation Repository Tools

MEDLINE-to-FHIR Converter

Citation Viewer
Citation Builder
Clinical Trial Results Reporter
Systematic Review Results Reporter

COVID-19 Knowledge Accelerator
Liaised network initiatives:

AHRQ ACTS COVID-19 Data-to-Evidence-to-Action Collaborative
COVID-END
FAIRness for FHIR

Systematic Meta-Review Project:

Steroid therapy for COVID-19

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COKA Activities – all 4 components

Contextualized application for each instance

Specific content and people

Common format for how data elements are expressed

Schema

Common interfaces (UIs and APIs) and data transformations

Tooling

Common vocabulary and code systems

Terminology

FHIR Citation Resource
FHIR EvidenceReport Resource
FHIR Evidence Resource

FHIR EvidenceVariable Resource
FHIR Group Resource
FHIR Statistic Resource [Datatype]

Study Design Code System
Statistic Code System

Statistic Type Code System

Statistic Model Code System
Certainty Code System
Risk of Bias Code System

Citation Repository Tools

MEDLINE-to-FHIR Converter

Citation Viewer
Citation Builder
Clinical Trial Results Reporter
Systematic Review Results Reporter

COVID-19 Knowledge Accelerator
Liaised network initiatives:

AHRQ ACTS COVID-19 Data-to-Evidence-to-Action Collaborative
COVID-END
FAIRness for FHIR

Systematic Meta-Review Project:

Steroid therapy for COVID-19

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Fast Healthcare Interoperability Resources (FHIR)

Evidence	EvidenceVariable	EvidenceReport	Citation	Group

Source: http://build.fhir.org

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Fast Healthcare Interoperability Resources (FHIR)

Evidence	EvidenceVariable	EvidenceReport	Citation	Group

Source: http://build.fhir.org

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Fast Healthcare Interoperability Resources (FHIR)

Evidence	EvidenceVariable	EvidenceReport	Citation	Group

FHIR Resources for Evidence Expression

Primary Resources

Datatype Resources

Statistic

Source: http://build.fhir.org

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Citation Resource

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COKA Activities – all 4 components

Contextualized application for each instance

Specific content and people

Common format for how data elements are expressed

Schema

Common interfaces (UIs and APIs) and data transformations

Tooling

Common vocabulary and code systems

Terminology

FHIR Citation Resource
FHIR EvidenceReport Resource
FHIR Evidence Resource

FHIR EvidenceVariable Resource
FHIR Group Resource
FHIR Statistic Resource [Datatype]

Study Design Code System
Statistic Code System

Statistic Type Code System

Statistic Model Code System
Certainty Code System
Risk of Bias Code System

Citation Repository Tools

MEDLINE-to-FHIR Converter

Citation Viewer
Citation Builder
Clinical Trial Results Reporter
Systematic Review Results Reporter

COVID-19 Knowledge Accelerator
Liaised network initiatives:

AHRQ ACTS COVID-19 Data-to-Evidence-to-Action Collaborative
COVID-END
FAIRness for FHIR

Systematic Meta-Review Project:

Steroid therapy for COVID-19

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COKA Activities – all 4 components

Contextualized application for each instance

Specific content and people

Common format for how data elements are expressed

Schema

Common interfaces (UIs and APIs) and data transformations

Tooling

Common vocabulary and code systems

Terminology

FHIR Citation Resource
FHIR EvidenceReport Resource
FHIR Evidence Resource

FHIR EvidenceVariable Resource
FHIR Group Resource
FHIR Statistic Resource [Datatype]

Study Design Code System
Statistic Code System

Statistic Type Code System

Statistic Model Code System
Certainty Code System
Risk of Bias Code System

Citation Repository Tools

MEDLINE-to-FHIR Converter

Citation Viewer
Citation Builder
Clinical Trial Results Reporter
Systematic Review Results Reporter

COVID-19 Knowledge Accelerator
Liaised network initiatives:

AHRQ ACTS COVID-19 Data-to-Evidence-to-Action Collaborative
COVID-END
FAIRness for FHIR

Systematic Meta-Review Project:

Steroid therapy for COVID-19

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Tools Development

MEDLINE-to-FHIR Converter

Login first at https://fevir.net/

Go to https://fevir.net/medlineconvert

Enter a PMID and it automatically generates a FHIR Citation.

Citation Viewer and Citation Builder

Available at https://fevir.net/

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COKA Activities – all 4 components

Contextualized application for each instance

Specific content and people

Common format for how data elements are expressed

Schema

Common interfaces (UIs and APIs) and data transformations

Tooling

Common vocabulary and code systems

Terminology

FHIR Citation Resource
FHIR EvidenceReport Resource
FHIR Evidence Resource

FHIR EvidenceVariable Resource
FHIR Group Resource
FHIR Statistic Resource [Datatype]

Study Design Code System
Statistic Code System

Statistic Type Code System

Statistic Model Code System
Certainty Code System
Risk of Bias Code System

Citation Repository Tools

MEDLINE-to-FHIR Converter

Citation Viewer
Citation Builder
Clinical Trial Results Reporter
Systematic Review Results Reporter

COVID-19 Knowledge Accelerator
Liaised network initiatives:

AHRQ ACTS COVID-19 Data-to-Evidence-to-Action Collaborative
COVID-END
FAIRness for FHIR

Systematic Meta-Review Project:

Steroid therapy for COVID-19

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FHIR CONNECTATHON EBM/COKA TRACK GOALS

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Track Description

Demonstrate data exchange using Evidence, EvidenceVariable, Group and EvidenceReport resources to communicate clinical trial and systematic review findings.
Demonstrate data exchange using Citation Resource to communicate location of computable biomedical knowledge artifacts.
Overcome the gap in the flow from the creation of evidence (research results, data analysis) to synthesis of evidence to inform decision support.

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Track Scenario 1

Share a list of selected research articles about COVID-19

Action: The Citation Manager will transmit a list of selected research articles as a bundle of Citation Resources.
Success Criteria: A different Citation Manager will reliably display the list of selected research articles.
Bonus point: Transfer of multiple identifiers related to an article that were not previously used in the Citation Manager (for example CORD-19 unique ID)

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Track Scenario 2

Share a list of selected computable biomedical knowledge artifacts (CBKs)

Action: The Citation Manager will transmit a list of selected CBKs as a bundle of Citation Resources.
Success Criteria: A different Citation Manager will reliably display the list of selected CBKs.
Bonus point: Transfer of multiple classifiers related to a CBK that were not previously used in the Citation Manager (for example “the CBK is an executable app”)

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Track Scenario 3

Create computable expressions for the evidence variables related to COVID-19 clinical research

Action: The Evidence Variable Classifier will create EvidenceVariable Resources expressing the population, exposures and outcomes for a clinical research article.
Success Criteria: Valid EvidenceVariable Resources are understood and agreed by other Evidence Variable Classifiers
Bonus point: Association of EvidenceVariable Resources with EvidenceReport Resources and Evidence Resources.

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Track Scenario 4

Create computable expressions for the evidence (statistical summary of findings) related to COVID-19 clinical research

Action: The Evidence Classifier will create Evidence Resources for a clinical research article.
Success Criteria: Valid Evidence Resources are understood and agreed by other Evidence Classifiers
Bonus point: Association of Evidence Resources with EvidenceReport Resources and EvidenceVariable Resources.

© 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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EVIDENCE-BASED MEDICINE/COKA TRACK ACHIEVEMENTS

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Good Participation

10 people from 6 organizations

Brian S. Alper, Computable Publishing LLC

Khalid Shahin, Computable Publishing LLC

Joanne Dehnbostel, Computable Publishing LLC

Marc Hadley, MITRE Corporation

Michelle Caputy, MITRE Corporation

Falk von Dincklage, Charité - Universitätsmedizin Berlin

Gregor Lichtner, Charité - Universitätsmedizin Berlin

Geoff Low, Medidata Solutions, Vulcan

Kees van Bochove, The Hyve, FHIRforFAIR

Ana Carolina Loyola Briceno, Department of HHS, Office of Quality Improvement

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Citation Exchange Achievements

MITRE Corporation successfully loaded 2 Citation Resources onto FEvIR.net and they were viewed in Citation Viewer

Plans discussed to exchange classifiers to 2 Citation Resources for the same cited artifact

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Citation Resource Achievements

Multiple changes to value sets to support Citation Resource

https://jira.hl7.org/browse/FHIR-32322

Changes include real-world example needs (e.g. adding code-repository and restricted to ArticleUrlType value set)
Changes include mapping to Dublin Core Metadata Initiative standard (e.g. adding coverage to CitedArtifactClassificationType value set)

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Evidence Exchange Achievements

Charité - Universitätsmedizin Berlin presented draft Evidence, EvidenceVariable and Group Resources to express evidence from meta-analysis and net effect estimates.
Extensive discussion adjusted how to fit the EBMonFHIR model and how to adjust the EBMonFHIR model to better fit this function.

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EvidenceVariable Resource Achievements

Multiple changes to improve EvidenceVariable Resource

https://jira.hl7.org/browse/FHIR-32645 Reference(Any)

https://jira.hl7.org/browse/FHIR-32646 characteristic.type

https://jira.hl7.org/browse/FHIR-32647 characteristicCombination

any-of

all-of

at-least-n

net-effect

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Evidence Exchange Achievements

We created “COKA-EBM Clinical Outcomes in ACTT-1 Remdesivir RCT EvidenceReport” at https://fevir.net/resources/EvidenceReport/156

supported with

9 Evidence Resources
7 EvidenceVariable Resources
2 Group Resources
1 ActivityDefinition Resource

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QUESTIONS/NEXT STEPS

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Citation Exchange Next Steps

Adjust value sets for Citation Resource.
Complete development of Citation Builder and Citation Viewer on fevir.net to facilitate human-friendly editing and viewing with conversion to/from FHIR Citation json
Explore FHIR operations for “Exchange Classifiers” function.
Explore FHIR Subscription Framework for notifications function.
Consider when to start IG development.

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Evidence-related Next Steps

Complete structure changes to EvidenceVariable Resource.
Explore FHIR operations for “Evidence” functions.
Explore FHIR Subscription Framework for notifications function.
Consider when to start IG development.

© 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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Questions/Important Links

FHIR Specification (R5 Continuous integration build): http://build.fhir.org/
Track Confluence: https://confluence.hl7.org/pages/viewpage.action?pageId=97458212
JIRA: https://jira.hl7.org/projects/FHIR/issues
FHIR Chat: https://chat.fhir.org/
COKA page: https://confluence.hl7.org/pages/viewpage.action?pageId=97468919
Questions/Comments, email balper@computablepublishing.com

© 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4.0 International HL7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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