GIN 2025 Panel Intro

WHY ARE GUIDELINES SO MUCH WORK WITH CURRENT TECHNOLOGY?

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

CEO, Computable Publishing LLC

President, Scientific Knowledge Accelerator Foundation

Our Team

Computable Publishing LLC

​

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

3

​

​

​

​

​

​

​

​

​

​

.

DISCLOSURES

Owner, Computable Publishing LLC

• Computable Publishing LLC owns the Fast Evidence Interoperability Resources (FEvIR) Platform
• I would like you to pay me to make your guidelines computable
• BUT MY PRESENTATION IS LIMITED TO TOOLS YOU CAN USE FOR FREE

​

I also do a lot of charitable, nonprofit work

• GINTech
• EBMonFHIR (an HL7^® project to extend HL7^® FHIR^® to support computable evidence and guidance)
• Health Evidence Knowledge Accelerator
• Scientific Knowledge Accelerator Foundation

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International, and their use of these trademarks does not constitute an endorsement by HL7.

​

Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Produce guidance

​

Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Produce evidence

Evaluate and improve practice

Image adapted from MAGIC Evidence Ecosystem Foundation

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

​

Global standards

The Digital and Trustworthy

Evidence Ecosystem

HEALTHCARE KNOWLEDGE ECOSYSTEM TODAY

AMIA 2024 ANNUAL SYMPOSIUM | AMIA.ORG

7

Data

Evidence

Guidance

Action

HEALTHCARE KNOWLEDGE ECOSYSTEM DESIRED

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

AMIA 2024 Annual Symposium | amia.org

Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Produce guidance

​

Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Produce evidence

Evaluate and improve practice

Image adapted from MAGIC Evidence Ecosystem Foundation

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

​

Global standards

The Digital and Trustworthy

Evidence Ecosystem

HL7® FHIR® MAKES HEALTH DATA FAIR

• Fast Healthcare Interoperability Resources (FHIR)® is an HL7® standard for electronic data exchange, created by HL7 in 2011
• HL7 FHIR solves long-intractable problems of sharing health data
• Resources (the R in FHIR) is the technical HOW – small digital object as shareable value unit
• HL7 standards development process is the human HOW
• HL7 FHIR enables data to be Findable, Accessible, Interoperable and Reusable (FAIR)

​

HL7^®, and FHIR^® are the registered trademarks of Health Level Seven International and their use of these trademarks does not constitute an endorsement by HL7.

​

Produce guidance

Guidelines, Decision Aids, Clinical Decision Support

​

Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Systematic Reviews

Produce evidence

Research Studies

Evaluate and improve practice

NOT health data exchange

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

EBMonFHIR extends HL7 FHIR to EBM data

• FHIR Resources for Evidence-Based Medicine (EBM) Knowledge Assets project (EBMonFHIR) was approved on May 16, 2018 as an HL7 project.
• EBMonFHIR sponsored by 3 HL7 Work Groups
• Clinical Decision Support (CDS)
• Clinical Quality Information (CQI)
• Biomedical Research and Regulation (BRR)
• Goal: provide interoperability for clinical research (evidence) and recommendations for clinical care

AMIA 2024 Annual Symposium | amia.org

EBMonFHIR extends HL7 FHIR to EBM data

AMIA 2024 Annual Symposium | amia.org

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

15

FHIR REPRESENTATION OF A GUIDELINE INVOLVES MANY PARTS:

• Guideline Profile of Composition Resource – Introduction, Methods, Recommendations, Discussion, References, Competing Interests, Acknowledgements, Appendices
• Recommendation Profile of Composition Resource – Recommendation Specification (statement, ratings, population, action, opposite action), Evidence, Justification, Considerations
• RecommendationJustification Profile of ArtifactAssessment Resource – Recommendation Ratings, Evidence, Net Effect, Judgments (e.g. Costs, Equity, Acceptability, Feasibility)
• Evidence Resource – statistical findings and certainty of evidence
• RecommendationEligibilityCriteria Profile of Group Resource – precise definition of who the recommendation is for

EBMonFHIR extends HL7 FHIR to EBM data

• FHIR Resources for Evidence-Based Medicine (EBM) Knowledge Assets project (EBMonFHIR) was approved on May 16, 2018 as an HL7 project.
• EBMonFHIR sponsored by 3 HL7 Work Groups
• Clinical Decision Support (CDS)
• Clinical Quality Information (CQI)
• Biomedical Research and Regulation (BRR)
• Goal: provide interoperability for clinical research (evidence) and recommendations for clinical care

AMIA 2024 Annual Symposium | amia.org

EBMonFHIR extends HL7 FHIR to EBM data

AMIA 2024 Annual Symposium | amia.org

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

19

FHIR REPRESENTATION OF A GUIDELINE INVOLVES MANY PARTS:

• Guideline Profile of Composition Resource – Introduction, Methods, Recommendations, Discussion, References, Competing Interests, Acknowledgements, Appendices
• Recommendation Profile of Composition Resource – Recommendation Specification (statement, ratings, population, action, opposite action), Evidence, Justification, Considerations
• RecommendationJustification Profile of ArtifactAssessment Resource – Recommendation Ratings, Evidence, Net Effect, Judgments (e.g. Costs, Equity, Acceptability, Feasibility)
• Evidence Resource – statistical findings and certainty of evidence
• RecommendationEligibilityCriteria Profile of Group Resource – precise definition of who the recommendation is for

Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

MEDLINE

ClinicalTrials.gov

PICO Portal

McMaster University Evidence Alerts

GRADEpro

MAGICapp

DynaMed

MEDLINE

PICO Portal

McMaster University Evidence Alerts

MAGICapp

DynaMed

Standard Structured Form

GRADEpro

ClinicalTrials.gov

Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Evolution of the Health Evidence Knowledge Accelerator (HEvKA)

Health Evidence Knowledge �Accelerator (HEvKA)

• A virtual organization – no cost, no contracts
• Open, transparent – all meetings
• A way for any to volunteer to accelerate development and implementation of standards for evidence exchange, especially with attention to health evidence and evidence-based guidance

AMIA 2024 Annual Symposium | amia.org

Health Evidence Knowledge Accelerator (HEvKA)

�Content and support tools for making science computable and facilitating HEvKA projects can be found on the 

Fast Evidence Interoperability Resources (FEvIR) Platform https://fevir.net

The FEvIR HEvKA Project Page can be found at https://fevir.net/resources/Project/29272 

The FEvIR platform includes evidence-related resources in current (R6 – CI Build) FHIR format.

​

© 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.

27

HEvKA has 10 active working groups

© 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.

28

For all of these meetings: Join Microsoft Teams Meeting

If you wish to learn more about HEvKA please go to

https://tinyurl.com/HEvKA

Or FEvIR.net/HEvKA