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Forgive me if I'm mistaken, but isn't this exactly what the FHIR standard is meant to address? Not only does it enable global inter-health communication using a

Forgive me if I'm mistaken, but isn't this exactly what the FHIR standard is meant to address? Not only does it enable global inter-health communication using a standardized resource, but it's already adopted in several national health services, including (but not broadly), America. Is this not simply a reimplementation, but without the broad iterations of HL7?

nradov 2y ago
Right, it would make more sense to use HL7 FHIR (possibly along with CQL) as a starting point instead of reinventing the wheel. Talk to the CodeX accelerator about writing an Implementation Guide in this area. The PlanDefinition resource type should be a good fit for modeling cancer guidelines. https://codex.hl7.org/ https://codex.hl7.org/ https://www.hl7.org/fhir/plandefinition.html https://www.hl7.org/fhir/plandefinition.html
- joshuakelly 2y ago
  This is the comment I was looking for. You would aim to use CQL expressions inside of a PlanDefinition, in my estimate. This is exactly what AHRQ's, part of HHS, CDS Connect project aims to create / has created. They publish freely accessible computable decision support artifacts here: https://cds.ahrq.gov/cdsconnect/repository https://cds.ahrq.gov/cdsconnect/repository When they are fully computable, they are FHIR PlanDefinitions (+ other resources like Questionnaire, etc) and CQL. Here's an example of a fully executable Alcohol Use Disorder Identification Test: https://cds.ahrq.gov/cdsconnect/artifact/alcohol-screening-using-world-health-organization-who-alcohol-use-disorders https://cds.ahrq.gov/cdsconnect/artifact/alcohol-screening-u... There's so much other infrastructure around the EHR here to understand (and take advantage of). I think there's a big opportunity in proving that multimodal LLM can reliably generate these artifacts from other sources. It's not the LLM actually being a decision support tool itself (though that may well be promising), but rather the ability to generate standardized CDS artifacts in a highly scalable, repeatable way. Happy to talk to anyone about any of these ideas - I started exactly where OP was.
  - osmano807 2y ago
    I downloaded and opened an CDS for osteoporosis from the link (as a disease in my specialty), I need an API key to view what a "valueset" entails, so in practice I couldn't assert if the recommendation aligns with clinical practice, nor in the CQL provided have any scientific references (even a textbook or a weak recommendation from a guideline would be sufficient, I don't think the algorithm should be the primary source of the knowledge) I tried to see if HL7 was approachable for small teams, I personally became exhausted from reading it and trying to think how to implement a subset of it, I know it's "standard" but all this is kinda unapproachable.
    - nradov 2y ago
      You can register for a free NLM account to access the value sets (VSAC). HL7 standards are approachable for small teams but due to the inherent complexity of healthcare it can take a while to get up to speed. The FHIR Fundamentals training course is a good option for those who are starting out. https://www.hl7.org/training/fhir-fundamentals.cfm?ref=nav https://www.hl7.org/training/fhir-fundamentals.cfm?ref=nav It might seem tempting to avoid the complexity of FHIR and CQL by inventing your own simple schema or data formats for a narrow domain. But I guarantee that what you thought was simple will eventually grow and grow until you find that you've reinvented FHIR — badly. I've seen that happen over and over in other failed projects. Talk to the CodeX accelerator I linked above and they should be able to get you pointed in the right direction.

nradov 2y ago

Right, it would make more sense to use HL7 FHIR (possibly along with CQL) as a starting point instead of reinventing the wheel. Talk to the CodeX accelerator about writing an Implementation Guide in this area. The PlanDefinition resource type should be a good fit for modeling cancer guidelines. https://codex.hl7.org/ https://codex.hl7.org/ https://www.hl7.org/fhir/plandefinition.html https://www.hl7.org/fhir/plandefinition.html

joshuakelly 2y ago
This is the comment I was looking for. You would aim to use CQL expressions inside of a PlanDefinition, in my estimate. This is exactly what AHRQ's, part of HHS, CDS Connect project aims to create / has created. They publish freely accessible computable decision support artifacts here: https://cds.ahrq.gov/cdsconnect/repository https://cds.ahrq.gov/cdsconnect/repository When they are fully computable, they are FHIR PlanDefinitions (+ other resources like Questionnaire, etc) and CQL. Here's an example of a fully executable Alcohol Use Disorder Identification Test: https://cds.ahrq.gov/cdsconnect/artifact/alcohol-screening-using-world-health-organization-who-alcohol-use-disorders https://cds.ahrq.gov/cdsconnect/artifact/alcohol-screening-u... There's so much other infrastructure around the EHR here to understand (and take advantage of). I think there's a big opportunity in proving that multimodal LLM can reliably generate these artifacts from other sources. It's not the LLM actually being a decision support tool itself (though that may well be promising), but rather the ability to generate standardized CDS artifacts in a highly scalable, repeatable way. Happy to talk to anyone about any of these ideas - I started exactly where OP was.
- osmano807 2y ago
  I downloaded and opened an CDS for osteoporosis from the link (as a disease in my specialty), I need an API key to view what a "valueset" entails, so in practice I couldn't assert if the recommendation aligns with clinical practice, nor in the CQL provided have any scientific references (even a textbook or a weak recommendation from a guideline would be sufficient, I don't think the algorithm should be the primary source of the knowledge) I tried to see if HL7 was approachable for small teams, I personally became exhausted from reading it and trying to think how to implement a subset of it, I know it's "standard" but all this is kinda unapproachable.
  - nradov 2y ago
    You can register for a free NLM account to access the value sets (VSAC). HL7 standards are approachable for small teams but due to the inherent complexity of healthcare it can take a while to get up to speed. The FHIR Fundamentals training course is a good option for those who are starting out. https://www.hl7.org/training/fhir-fundamentals.cfm?ref=nav https://www.hl7.org/training/fhir-fundamentals.cfm?ref=nav It might seem tempting to avoid the complexity of FHIR and CQL by inventing your own simple schema or data formats for a narrow domain. But I guarantee that what you thought was simple will eventually grow and grow until you find that you've reinvented FHIR — badly. I've seen that happen over and over in other failed projects. Talk to the CodeX accelerator I linked above and they should be able to get you pointed in the right direction.