EBM-on-FHIR�(Evidence Based Medicine-on-FHIR)�September 24, 2020
Brian S. Alper, MD, MSPH, FAAFP, FAMIA
CEO, Computable Publishing LLC
Project Lead, EBMonFHIR
Project Lead, COVID-19 Knowledge Accelerator (COKA)
Slides available at https://tinyurl.com/COKAfolder
Questions: balper@computablepublishing.com
Introductions
Health Level 7 International (HL7®) is a standards development organization
Fast Healthcare Interoperability Resources (FHIR®) is an HL7 standard that SOLVES the BIG problem in making healthcare data Findable, Accessible, Interoperable and Reusable (FAIR)
Evidence-Based Medicine/Practice (EBM/P) is a community that has the BIG problem of scientific results (evidence) is not FAIR, and there is no universal standard
EBMonFHIR is an HL7 project to extend FHIR to EBM knowledge assets – make evidence FAIR – started May 2018
COVID-19 Knowledge Accelerator (COKA) is a virtual organization (> 25 groups in > 7 countries meeting 12 times/week) to accelerate EBMonFHIR and related efforts for COVID-19 knowledge – started March 2020
The Knowledge Ecosystem – Clinical Knowledge View
Making decisions and doing things.
ACTION
Advice and information to facilitate making decisions.
GUIDANCE
The observations and measurements of things.
DATA
The analysis of data and understanding of likelihoods of things.
EVIDENCE
Outer ring - General Layer
The Knowledge Ecosystem – Clinical Knowledge View
Making decisions and doing things.
ACTION
Advice and information to facilitate making decisions.
GUIDANCE
The observations and measurements of things.
DATA
The analysis of data and understanding of likelihoods of things.
EVIDENCE
Outer ring - General Layer
Specific Layer
The Knowledge Ecosystem – Clinical Knowledge View
Making decisions and doing things.
ACTION
Advice and information to facilitate making decisions.
GUIDANCE
The observations and measurements of things.
DATA
The analysis of data and understanding of likelihoods of things.
EVIDENCE
Outer ring - General Layer
Specific Layer
Computable Layer
The Knowledge Ecosystem – Clinical Knowledge View
Making decisions and doing things.
ACTION
Advice and information to facilitate making decisions.
GUIDANCE
The observations and measurements of things.
DATA
The analysis of data and understanding of likelihoods of things.
EVIDENCE
Outer ring - General Layer
Specific Layer
Computable Layer
Executable Layer
The Knowledge Ecosystem – Clinical Knowledge View
CORE
Making decisions and doing things.
ACTION
Advice and information to facilitate making decisions.
GUIDANCE
The observations and measurements of things.
DATA
The analysis of data and understanding of likelihoods of things.
EVIDENCE
Outer ring - General Layer
Specific Layer
Computable Layer
Executable Layer
What do we need to do in early developmental stages?
Demonstrating computable data exchange instead of digital data exchange.
Learning from real-world steps BEFORE writing how-to.
1. schema/model of FHIR Resources
FHIR Resources at Maturity Level 1
FHIR Resources at Maturity Level 0
What does computable evidence look like?
DIGITAL EVIDENCE Published July 20, 2020 https://gps.health/coka/reports/EvidenceReport/28
COMPUTABLE EVIDENCE at https://gps.health/coka/resources/EvidenceReport/28?version=8
EvidenceVariable Resource
1. schema/model of FHIR Resources
FHIR Resources at Maturity Level 1
FHIR Resources at Maturity Level 0
2. Code systems and value sets
For these 6 evidence-related FHIR Resources we created 35 different value sets (and thus 35 different code systems) where no existing code systems were adequate.
The process (derived from FHIR Resource generation) was not set up for creation of code systems.
We created a Code System Development Protocol
1. Assemble an expert working group.
2. Identify tools or systems commonly used today to express these concepts.
3. Map out a single list of non-redundant concepts for common needs.
4. Map related terms and definitions in all freely available ontologies.
5. Determine the optimal phrasing for terms and definitions in the code system.
6. Achieve (near-)universal agreement in the code system.
7. Evaluate implementation of the code system.
8. Maintain systems for continuous code system refinement.
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2. Code systems and value sets
We are working now on creating 4 Code Systems:
Study Design Code System to describe methodology characteristics of scientific observations such as randomized assignment, crossover allocation to cohorts, and qualitative analysis.
Statistic Type Code System to describe the statistics reported such as mean, median, proportion, relative risk, absolute risk difference, p value, confidence interval, and I-squared measure of heterogeneity.
Statistic Model Code System to describe the model characteristics such as linear regression, random-effects analysis, and tau estimation method.
Risk Of Bias Code System to describe the concerns with methods or reporting of scientific observations such as comparator selection bias, gaps in blinding, and selective outcome reporting.
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Early mapping work led us to realize we needed more structure for how we create the code systems
2. Code systems and value sets
You can join any of the Expert Working Groups.
Read the Invitation to join Expert Working Group
Complete the Code System Development Intake Form
36 people from 19 countries (5 continents) have signed up so far
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3. Demonstrating that data exchange can work
Content Citation and Classification Tools Development Work Group
Evidence Evaluation and Reporting Tools Development Work Group
Systematic Meta-Review Project Group
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COKA Weekly Meeting Schedule
Day | Time (Eastern) | Team |
Monday | 7-8 am | Project Management |
Monday | 9-10 am | Systematic Meta-Review |
Monday | 4-5 pm | Statistic Model Code System Development |
Tuesday | 10-11 am | Evidence Evaluation and Reporting Tools Development |
Tuesday | 2-3 pm | Study Design Code System Development |
Wednesday | 8-9 am | Knowledge Ecosystem Liaison |
Wednesday | 9-10 am | Statistic Type Code System Development |
Thursday | 7-8 am | Project Management |
Thursday | 9-10 am | Content Citation and Classification Tools Development |
Thursday | 4-5 pm | Project Management |
Friday | 9-10 am | Risk of Bias Code System Development |
Friday | 10-11 am | Communications (Awareness, Scholarly Publications) |
For all of these meetings: Join Microsoft Teams Meeting
If you wish to sign up or learn more about COKA please go to
https://www.gps.health/covid19_knowledge_accelerator.html
Questions: balper@computablepublishing.com
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