Montreal Connectathon Report & Next Steps for CDS Hooks
Josh Mandel
Dear CDS Hooks Hackers,
I want to update you on progress since our big-group phone call!
FHIR Connectathon in Montreal
We hosted our second successful Connectathon this week, with participation from multiple EHR providers (Allscripts, Cerner, Epic, Oridashi) and CDS provider organizations (Healthwise, IMO, RxREVU, Syapse). We saw prototype integration of simple "information cards" in a Cerner and Epic environment, and we saw services built to provide information including drug interactions, pill images, and clinical best practice notices.
We also hosted a quick design session to develop a strategy for feedback and analytics, to ensure that CDS Service developers have a way to answer questions like "did the user click my suggestion?" (solution: we defined a simple HTTP callback), and then more broadly "... and what happened later?" (solution: leverage the FHIR REST API).
Specification and Documentation Updates
With a big lift from Kevin Shekleton, we've published an updated specification that streamlines the way CDS Services are invoked, and updated docs including a new landing page at http://cds-hooks.org/. To summarize changes: we've defined a simplified service discovery publication format based on straightforward JSON documents, and we've published a structured description of the endpoints with Swagger.
The feedback from the Connectathon participants towards the new API was very positive. We know that many of you couldn’t be with us this past weekend in Montreal, so we’d love to hear your feedback on the new API after you have an opportunity to play with it. (For those who were at the connectathon: note that we've further simplified the API by removing ".well-known/" from the discovery endpoint.)
New Tools, Services, and Examples
We've been working on a set of tools and services to support CDS developers and EHR integrations. For a quick overview, see our list of "help wanted" issues —and note that thanks to an incredible push from Matt Berther at Healthwise, we're rapidly plowing through this infrastructure development work. Briefly: we have a "test card service" deployed at https://test-service.cds-hooks.org to expose sample (fixture) cards, and work is beginning on a "prefetch proxy" service to automatically perform "prefetch" access in cases where the EHR does not fully support this feature.
What’s Next
We welcome any help on the aforementioned “help wanted” issues or any other contributions to the code or documentation that we have out in our Github repository.
While we just finished our Connectathon in Montreal, planning for the next Connectathon in Baltimore this September is already underway! Four ideas for focus areas in September:
Security: While we have thoughts on how security would be handled within the CDS Hooks space, we haven’t formally discussed or implemented this approach yet. This is something we would like to discuss early (May, June) and then quickly implement (July, August) to get feedback. If this process goes well, we'd test the resulting approach across the wider community in September.
Prefetched Data: There are outstanding design decisions about how "prefetch" data behaves. For example, do EHRs need to support prefetch requests, or is this a "hint"? Additionally, we’re going to work on a prefetch proxy, and we’d like to see the effect this has on CDS service developers.
Define "trigger guards" for CDS Service Invocation: We’ve encountered several CDS services that are only relevant for a particular set of patients. For instance, a bilirubin CDS service would only be of interest to newborns, so it would be optimal if the EHR would only call the service for that subset of qualifying patients. We should discuss this topic and explore conventions that could help.
App links for SMART: In our current design, "app link" cards are just plain web links, with no special support for the SMART app launch specification. We should discuss whether additional support could enable better integration between SMART and CDS Hooks.
Thank You!
Though it has been a while since we all last talked, I’m very happy with the immense interest and progress we’ve made on CDS Hooks. It’s clear there is a very real need for simple, open specifications that support in-workflow decision support — and it’s been great seeing positive feedback from the community on CDS Hooks. Thanks again to everyone who was able to participate with us at the Montreal Connectathon and I’m looking forward to working with the rest of you here!
Don't hesitate to follow up with thoughts on the updated specifications, our plans for September, or additional focus areas you'd like to suggest.
Best,
Josh Mandel