Distributing Decision Support with FHIR
summary
Implements the CDC opioid guideline recommendation 5 as executable FHIR artifacts: value sets, PlanDefinition + ActivityDefinition rules, and a CQL library with ~1,000 drug entries that computes MME from RxNorm codes and dosage. Runs on a HAPI FHIR server with a CDS Hooks medication-prescribe prefetch so the MME >50 and >90 thresholds trigger four workflow actions. Six of twelve CDC recommendations are packaged and runnable; runtime versioning (STU2/STU3), terminology expansion, and EHR handling of returned requests remain fragile but functional.
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chapters (22)
- 0:00Intro
- 1:02Opioid Overdose Statistics
- 2:20The Running Example
- 3:12Implementation w/in a Health IT system
- 4:19Morphine milligram equivalents (MME/day)
- 5:47What is the implementation effort involved?
- 7:02Can't someone else do it?
- 8:32Clinical Reasoning Module
- 9:29Key Resources in Sharing Decision Support
- 13:02An aside about Opioid ValueSets
- 16:38An aside about process decisions
- 18:57Portable Opioid Management Terminology Knowledge
- 21:33Portable MME Calculation
- 23:05And a PlanDefinition to describe the rule
- 25:01COL Evaluation Architecture
- 26:16Native CQL (ELM) Engine
- 27:23Java-Based COL Engine
- 28:09Dynamic Expressions enables....
- 29:02CDS Hooks Integration
- 31:21Issues
- 33:45"General" implementation
- 36:52Walkthroughs
