Clinical Decision Support (CDS) for Immunizations FHIR Implementation Guide (PSS-2764)

This Jira PSS draws from and replaces an older PSS (see [Project 1342 |[https://www.hl7.org/special/Committees/projman/projectForm.cfm?action=view&ProjectNumber=1342])] but changes the realm from US to Universal. At the time of the original PSS, international participation was not in place despite the use case being of international significance. Since then, additional, non-US participants have joined the group.

Also note that [version 1.0.0 of the ImmDS FHIR IG |https://hl7.org/fhir/us/immds/] has been published. The project team is working on a new version for ballot and publication.

Clinical Decision Support for Immunizations is increasingly being used in health information systems to indicate which vaccinations a patient is due for next. Many of these expert systems are built as stand-alone systems that respond to web service requests. While these independent systems have similar requirements and outputs they use different web service standards. This project aims to create a common FHIR implementation guide that these expert systems may use to provide a common consistent interface. This common interface will be used for two main purposes:

- Provide a common interface that can be used for testing and verifying that these CDS engines are working correctly.

- Provide a common interface that health information systems may write to and gain access to their choice of CDS engines.

It is important to note that this standard will be used like an 'API' interface for system-to-system communication with a primary focus on supporting the current needs of Immunization Information Systems. However, this same interface may be leveraged by other systems such as Electronic Health Record (EHR) systems or other systems that manage immunizations. The common interface being proposed will be built to transmit raw and unformatted immunization evaluations and recommendations which will need to be further adapted before inclusion in any workflow or process. This adaption and use is beyond the scope of this project.

CDS Hooks is a related effort that proposes a standard for integrating Clinical Decision Support into clinical workflows. This project will coordinate its efforts with the CDS Hooks project to ensure the final solution is consistent with the larger vision of clinical decision support.

A lot of groundwork has already been laid for this project, and the work will simply pull all of this together for a final guide:

- The Public Health WG has supported the creation and maintenance of the Immunization and ImmunizationRecommendation resources, both of which will be central to this project. (No changes to these resources are anticipated in order for this project to succeed.)

- AIRA and AEGIS have prototyped the concept at FHIR Connectathons using the resources above and were able to reach operation stage within a day. The proposed project will not be breaking new technical ground.

- The processing model for how these CDS engines work for immunizations has already been standardized by the CDC sponsored CDSi project. This project will only focus on the mechanics of input and output, not the processing or expert logic.

- Project team has access to several open source CDS engines that can be adapted and demonstrated to work in this project.

- AIRA has prototyped the concept of using CDS Hooks at the 2017 May FHIR Connectathon to return recommendations to an EHR system and has demonstrated that it can be done.

The project will review existing FHIR profiles for suitability before creating any new profiles.