1 of 30

WGM 2021-09-23

Evidence-Based Medicine (EBMonFHIR) and COVID-19 Knowledge Accelerator (COKA)

Brian Alper: balper@computablepublishing.com

https://docs.google.com/presentation/d/1dRkpbB3ABpraiEq-WV-Zq2t5F_7LFMun

© 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.

2 of 30

Agenda

EBMonFHIR Project Update
Connectathon Report Out
Recommendation Profile of PlanDefinition Resource
ArtifactComment Resource Proposal
Citation changes – FHIR-33421, FHIR-31864, FHIR-32322
EvidenceVariable change – FHIR-32645
EvidenceReport change – FHIR-31867
Common Metadata Framework update

© 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.

2

3 of 30

EBM-ON-FHIR Project Update

© 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.

3

4 of 30

4

5 of 30

Evidence-Based Medicine using FHIR

Examples at fevir.net include:

Many examples of Citation, Evidence, EvidenceVariable, Group, EvidenceReport, and ResearchStudy Resources
Automated conversion to FHIR Resources for PubMed Medline Citations and for ClinicalTrials.gov study registry entries

AHRQ CEDAR project using Citation in development of FHIR server for AHRQ knowledge repository

© 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.

5

6 of 30

Major Resource Changes

RelatedArtifact Datatype changed to support relatesTo element in Citation, EvidenceReport, ResearchStudy, others
EvidenceReport Resource will change to EvidenceReport Profile of Composition Resource
ArtifactComment – new Resource
Recommendation – new Resource (likely Profile of PlanDefinition)

© 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.

6

7 of 30

Major Code System Developments

Scientific Evidence Code System

Risk of Bias code system – 55 terms 100% approved so far
Study Design code system – 27 terms 100% approved so far
Statistic Type code system
Statistical Model code system

© 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.

7

8 of 30

Connectathon Track Report Out

© 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.

8

9 of 30

Connecthaton Track Report

5 people introduced to EBMonFHIR
Proposed track agenda superseded by high-priority developments for demonstration of EvidenceReport

selected outcomes from RCT (and detailed Risk of Bias assessment) -- for NEJM (https://fevir.net/resources/EvidenceReport/18816) and medRxiv preprint (https://fevir.net/resources/EvidenceReport/18824)
a table of individual trial summaries (https://fevir.net/resources/EvidenceReport/18831)
a Summary of Findings (table using meta-analysis else individual trial results) (https://fevir.net/resources/EvidenceReport/18881)

© 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.

9

10 of 30

Recommendation Profile of PlanDefinition

© 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.

10

11 of 30

Recommencation Resource (“Proposal”)

Likely Recommendation Profile of PlanDefinition

https://docs.google.com/spreadsheets/d/1Ay9H--ypDtOjnASfwVaSuPI2YdqKbO_q/edit#gid=1310064706

Examplish:

https://fevir.net/recommendationtableviewer

© 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.

11

12 of 30

ArtifactComment Resource Proposal

© 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.

12

13 of 30

ArtifactComment Resource (Proposal)

Expansion for Patient Care and Care Plan and Patient Empowerment
https://confluence.hl7.org/display/FHIR/ArtifactComment+Fhir+Resource+Proposal
https://docs.google.com/spreadsheets/d/19-s6b9W0gosa-Cr5fxJtqThrTY0HView/edit#gid=1310064706

Examples:

https://fevir.net/resources/ArtifactComment/7762

https://fevir.net/resources/ArtifactComment/7841

© 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.

13

14 of 30

Citation changes

© 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.

14

15 of 30

Citation Resource

StructureDefinition http://build.fhir.org/citation.html
Example https://fevir.net/resources/Citation/115
Open items:

Change relatesTo to RelatedArtifact datatype
Change webLocation.type to webLocation.classifier

https://jira.hl7.org/browse/FHIR-33421

Add 6 terms to the CitationArtifactClassifier code system

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

Change contributorship.entry.listOrder to rankingOrder

https://jira.hl7.org/browse/FHIR-31864

© 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.

15

16 of 30

Other Resource changes

© 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.

16

17 of 30

EvidenceVariable Resource

StructureDefinition http://build.fhir.org/evidencevariable.html
Example https://fevir.net/resources/EvidenceVariable/7751
Recent changes:

Removed characteristic.timeFromStart (replaced with timeFromEvent)

Open items:

For characteristic.definition[x] – consider canonicalReference

https://jira.hl7.org/browse/FHIR-32645

© 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.

17

18 of 30

Group Resource

StructureDefinition http://build.fhir.org/group.html
Example https://fevir.net/resources/Group/7750
Recent changes:

none

Open items:

For characteristic.value[x] – add Expression data type

https://jira.hl7.org/browse/FHIR-33264

© 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.

18

19 of 30

Agenda

EBMonFHIR Project Update
Connectathon Report Out
Recommendation Profile of PlanDefinition Resource
ArtifactComment Resource Proposal
Citation changes – FHIR-33421, FHIR-31864, FHIR-32322
EvidenceVariable change – FHIR-32654
EvidenceReport change – FHIR-31867
Common Metadata Framework update

© 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.

19

20 of 30

EvidenceReport Resource

StructureDefinition http://build.fhir.org/evidencereport.html
Example https://fevir.net/resources/EvidenceReport/18881
Recent changes:

RelatedArtifact Datatype revised https://build.fhir.org/metadatatypes.html#RelatedArtifact

Open items:

Modify Composition Resource to change to EvidenceReport Profile

https://jira.hl7.org/browse/FHIR-31867

create an EvidenceSubject Profile of EvidenceVariable Resource

© 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.

20

21 of 30

Common Metadata Framework update

© 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.

21

22 of 30

Common Metadata Framework

Not an HL7- or FHIR-specific project
Started within Mobilizing Computable Biomedical Knowledge (MCBK)
Published: Categorizing metadata to help MCBK

https://onlinelibrary.wiley.com/doi/10.1002/lrh2.10271
13 categories of metadata for FAIR and Trust purposes

Current efforts: Specifying metadata to help MCBK

https://docs.google.com/spreadsheets/d/1ybUiSVsOcTJ3J4J9DR-4LZNcD36ZGfEM/edit#gid=16478556
FHIR-like format being used for the specification

© 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.

22

23 of 30

COVID-19 KNOWLEDGE ACCELERATOR 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.

23

24 of 30

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

© 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.

24

25 of 30

COKA has 11 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)
Computable EBM Tools Development WG
Systematic Meta-Review Project Group
Knowledge Ecosystem Liaison WG
Communications WG CDS EBM sub-WG

© 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.

25

26 of 30

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	8-9 am	Project Management
Monday	9-10 am	Systematic Meta-Review Project Group
Monday	11 am-12 pm	Computable EBM Tools Development WG
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	Computable EBM Tools Development WG
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)

27 of 30

Code System Development

We are following a 13-step Code System Development Protocol to develop and maintain 4 code systems.
Step 1 (Assemble Expert Working Group)

You are welcome to join this effort -- see Invitation to join Expert Working Group. At this time, we currently have 64 people signed up from 27 countries in 6 continents.
You can sign up now with the Code System Development Intake Form to join the expert working group for any of the first 4 code systems.

Step 2 (Identify common tools): 25 tools and systems identified for the code systems to support.
Step 3 (Draft terms): 485 non-redundant concepts identified to support the 25 tools and systems.
Step 4 (Identify relevant ontologies): We have 27 eligible Ontologies Identified for Code System Development.
Step 5 (Ontology mapping) is underway. 9 ontologies mapped so far, 18 to go.

28 of 30

Code System Development

We are following a 13-step Code System Development Protocol to develop and maintain 4 code systems.
Step 6 (Draft preferred term, alternative terms, definition)
Step 7 (Accept if 100% agreement from Expert Working Group [EWG] voting)
Step 8 (Revise from EWG suggestions and accept if 100% agreement)
Step 9 (Deliberate with group discussion and accept if 80% agreement)
Step 10 (Collaborate with ontologies that provide majority of contribution to agreed codes)
Step 11 (Publish the code system)
Step 12 (Support implementation and revise as needed)
Step 13 (Support ongoing maintenance with continuous application of steps 1-12)

18 Terms have reached 100% agreement as of May 24, 2021.

29 of 30

Code System Development

As of September 19, 2021:

55 Risk of Bias Code System terms have 100% agreement
27 Study Design Code System terms have 100% agreement

Scientific Evidence Code System

30 of 30

Questions/Important Links

FHIR Specification (R5 Continuous integration build): http://build.fhir.org/
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.

30