Abstract
BackgroundEvidence-based guidelines and recommendations can be transformed into “If-Then” Clinical Evidence Logic Statements (CELS). Imaging-related CELS were represented in standardized formats in the Harvard Medical School Library of Evidence (HLE).ObjectiveWe aimed to (1) describe the representation of CELS using established Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT), Clinical Quality Language (CQL), and Fast Healthcare Interoperability Resources (FHIR) standards and (2) assess the limitations of using these standards to represent imaging-related CELS.MethodsThis study was exempt from review by the Institutional Review Board as it involved no human subjects. Imaging-related clinical recommendations were extracted from evidence sources and translated into CELS. The clinical terminologies of CELS were represented using SNOMED CT and the condition-action logic was represented in CQL and FHIR. Numbers of fully and partially represented CELS were tallied.ResultsA total of 765 CELS were represented in the HLE as of December 2018. We were able to fully represent 137 of 765 (17.9%) CELS using SNOMED CT, CQL, and FHIR. We were able to represent terms using SNOMED CT in the temporal component for action (“Then”) statements in CQL and FHIR in 755 of 765 (98.7%) CELS.ConclusionsCELS were represented as shareable clinical decision support (CDS) knowledge artifacts using existing standards—SNOMED CT, FHIR, and CQL—to promote and accelerate adoption of evidence-based practice. Limitations to standardization persist, which could be minimized with an add-on set of standard terms and value sets and by adding time frames to the CQL framework.
Highlights
BackgroundImaging clinical decision support (CDS) applies health information technology (IT) to inform clinical decision making at the point of care regarding the need for imaging or the optimal study based on the best available evidence [1]
To be widely shared and usable in such systems, Clinical Evidence Logic Statements (CELS) must be translated into established standardized syntax and formats such as Systematized Nomenclature of Medicine—Clinical Terms (SNOMED Computed Tomography (CT)) [8], Clinical Quality Language (CQL) [9], and Fast Healthcare Interoperability Resources (FHIR) [10]
We were able to represent terms using SNOMED CT in the temporal component for action (“”) statements in CQL and FHIR in 755 of 765 (98.7%) of CELS
Summary
BackgroundImaging clinical decision support (CDS) applies health information technology (IT) to inform clinical decision making at the point of care regarding the need for imaging or the optimal study based on the best available evidence [1]. Regulations promulgated in response to the Protecting Access to Medicare Act (PAMA) state that health care providers should reference appropriate use criteria or evidence-based clinical knowledge while ordering certain advanced imaging exams [4]. To be widely shared and usable in such systems, CELS must be translated into established standardized syntax and formats such as Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) [8], Clinical Quality Language (CQL) [9], and Fast Healthcare Interoperability Resources (FHIR) [10]. Objective: We aimed to (1) describe the representation of CELS using established Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT), Clinical Quality Language (CQL), and Fast Healthcare Interoperability Resources (FHIR) standards and (2) assess the limitations of using these standards to represent imaging-related CELS. Limitations to standardization persist, which could be minimized with an add-on set of standard terms and value sets and by adding time frames to the CQL framework
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