immunization calculation engine (ice)

Immunization Calculation Engine (ICE)

An Open-Source, Configurable Clinical Decision Support System that Integrates with Any Clinical Information

Systemthrough a Standards-Based Web Service Interface

– Utilized for Immunizations

Public Health Informatics Conference 2014

Michael Suralik, HLN Consulting, LLC

Regina Austin, HLN Consulting, LLC

April 29, 2014

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Agenda

Clinical Decision Support Services The ICE Software System Integrating ICE with Clinical Information

Systems

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Benefits of CDS

Improved quality of care

Better health outcomes

Avoidance of errors and adverse of events

Improved efficiency

Reduced costs

Increased provider/patient satisfaction

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CDS is Not Widely Available

CDS is complex

CDS capabilities have been tightly coupled with specific institutions

and health IT systems

Re-using CDS implemented elsewhere is difficult

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The Need

Application-independent CDS resources that can be

efficiently leveraged by diverse healthcare systems and

health IT settings to improve patient health

OpenCDS

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Collaborative project, led by Dr.

Kensaku Kawamoto at the

University of Utah

A software platform and toolkit

for developers implementing

CDS services

Open source

www.opencds.org

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ICE Project

Collaboration of public health agencies, academic researchers, and a private firm

Leveraged OpenCDS to implement CDS for immunizations (aka “immunization forecasting”)

Needed by providers and public health agencies

The ICE Project

ICE Software System

ICE Web Service Provides immunization forecasting to clinical

systems through a web service interface Supports routinely administered vaccine

groups, from infant to adult

CDS Administration Tool (CAT) Web-based tool enables non-technical subject

matter experts (SMEs) to manage ICE Human readable rules

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ICE Web Service

Inputs: DOB, gender, immunization history, disease

immunity Immunization schedule identifier, date of

evaluation

Outputs: Validity of immunization history + reasons Immunization recommendations + reasons

Sample ICE Deployment

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Software Architecture

ICE/OpenCDS Tomcat or JBoss AS (aka “WildFly”) JBoss Drools (rule engine/database) JBoss jBPM (process/workflow) HL7 vMR (data model)

CAT JavaServer Faces (GUI) Enterprise JavaBeans (business logic) Apache Derby JVM (database)

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Ease of Adoption and Integration with Clinical

Information Systems

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Open-Source

ICE built with only open-source software No dependencies on any commercial

software Released under a standard open-source

license GNU Lesser General Public License

version 3 (LGPL v3) Any system (even proprietary systems) may

use/modify/integrate with ICE at no cost Any modifications to ICE software must be

shared No warranty

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Flexible Deployment Options

Java-based system runs on variety of hardware/operating system platforms

Deploys on same or different server as the client system

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Standards-Based Interface

Attribute of ICE

Conforms to Relevant Technical Standard

Messaging framework

Simple Object Access Protocol (SOAP)

Web Service interface

Decision Support Service (DSS) – an HL7 & OMG standard– http://hssp-dss.wikispaces.com

Data model Virtual Medical Record (vMR) – an HL7 standard– http://wiki.hl7.org/index.php?title=Virtual_Medical_Record_(vMR)

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ICE Wiki

www.cdsframework.org

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Technical Documentation ofICE’s Standards-Based Interface

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Production Use of ICEby an EHR System

eClinicalWorks (eCW) v10 uses ICE to deliver evaluations and recommendations

Integrated by eCW developers, with minimal support from ICE team

No modifications to the default configuration

ICE is hosted by eCW at central location

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Summary of the ICE Software System

Freely available

Standards-based

Easily integrates with other systems

Maintainable by non-developers

Collaboratively developed

Transparent

Can be leveraged for other types of CDS

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Leverage Our Work

for Other Types of CDS

Drug interaction/allergy (warning)

Abnormal lab result (alert)

Ordering of appropriate lab test (critique)

Disease management (reminder)

Treatment/care plans (recommendation)

Automated redaction of sensitive data from clinical documents

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Clinical Decision Support Administration Tool

(CAT)

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Clinical Decision Support Administration Tool (CAT)

Graphical user interface Non-technical SMEs may configure

ICE Create, edit, delete…

Vocabulary and code sets Schedule parameters Rules Test cases

Can expand to other clinical domains

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Code System Editor

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Vaccine Editor

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Vaccine Series Editor

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Rule Editor - Example: Varicella Rule for Patients Born before 01/01/1980

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Test Editor (Test Case View)

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Test Editor (Test Results View)

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For More Information about ICE…

Mike Suralik 856-751-1094

suralik@hln.com

OR

URL: www.hln.com/iceEmail: ice@hln.com