Coordinated use of Health Level 7 standards to support clinical decision support: Case study with shared decision making and drug-drug interactions.

Abstract

Despite advances in interoperability standards, it remains challenging and often costly to share clinical decision support (CDS) across healthcare organizations. This is due in part to limited coordination among CDS components. To improve coordination of CDS components, Health Level 7 (HL7) has developed a suite of interoperability standards with Fast Health Interoperability Resources (FHIR) specification as a common information model. Evidence is needed to determine the feasibility of implementing these CDS components; therefore, the objective of this study was to investigate the coordination of emerging HL7 standards with modular CDS architecture components. We used a modular, standards-based architecture consisting of four components: data, logic, services, and applications. The implementation use-case was an application to support shared decision making in the context of drug-drug interactions (DDInteract). DDInteract uses FHIR as the data representation model, Clinical Quality Language for logic representation, CDS Hooks for the services layer, and Substitutable Medical Apps Reusable Technologies for application integration. DDInteract was first implemented in a sandbox environment and then in an electronic health record (Epic®) test environment. DDInteract can be integrated in clinical workflows through on-demand access from a menu or through CDS Hooks upon opening a patient's record or placing a medication order. In the context of drug interactions, DDInteract is the first application to leverage a full stack of emerging interoperability standards for each component of modular CDS architecture. The demonstrated feasibility of interoperable components can be generalized to other modular CDS applications.