EHR System Function and Information Model (EHR-S FIM is based on EHR-S FM R2.0) CPS.3.9 Clinical Decision Support System Guidelines Updates aka S.3.7.1 in EHR-S FM R1.1 Stephen.Hufnagel@tma.osd.mil , facilitator January 27, 2012 - original February 24, 2012 last updated Call for Participation This work is being done by the HL7 EHR Interoperability Work-group, meeting every Tuesday at 4PM ET, dial-in: 1-770-657-9270, Passcode: 510269#  The most current artifacts are at: http://wiki.hl7.org/index.php?title=EHR_Interoperability_WG 9/17/2018 DRAFT WORKING DOCUMENT

CPS.3.9 Clinical Decision Support System Guidelines Updates Statement: The purpose of this function is to provide Clinical Decision Support (CDS) System Guidelines Updates Description: System content such as discharge instructions, clinical guidelines, formularies, and other knowledge bases should be capable of being maintained and updated, independent of a particular encounter. Clinical decision support rules may be applied to the system using a manual process. As standards are developed to represent these rules, an automated update will be recommended. Any process to update decision support rules should include the verification of the appropriateness of the rules to the system. This may include but not be limited to authenticity of the source, the currency of the version, and any necessary approvals before updates can take place. Example: (Notional Scenario) As the EHR system maintains clinical content and rules, it determines that CDS rules are validated, updated, update dates are captured and that appropriate reminders and alerts are sent to appropriate Health Care Professionals. During patient encounters, the version of guidelines, provided to clinicians, are captured with the encounter notes, according to scope of practice, organizational policy and/or jurisdictional law. 9/17/2018 RED: delete, Blue: insert DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.3.9 Clinical Decision Support System Guidelines Updates Activities Mapped-to System-Components 9/17/2018 DRAFT WORKING DOCUMENT

CPS.3.9 Clinical Decision Support System Guidelines Updates Conceptual Information Model (CIM) Mapped to EHR-S Functions RECOMMENDATION: Add Clinical Decision Support Function to EHR-S FM 9/17/2018 RED: delete, Blue: insert DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.3.9 Clinical Decision Support System Guidelines Updates Conceptual Data Model (CDM) 9/17/2018 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.3.9 Clinical Decision Support System Guidelines Updates CDM Requirements-Traceability 9/17/2018 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.3.9 Clinical Decision Support System Guidelines Updates “See Also” Dependencies 9/17/2018 DRAFT WORKING DOCUMENT

Action Verb Hierarches Manage (Data) Capture Maintain Render Exchange Determine Manage- Data- Visibility Auto-Populate Enter Import Receive Store Update Remove Extract Present Transmit Export Analyze Decide De-Identify Hide Mask Re-Identify Unhide Unmask Archive Backup Decrypt Encrypt Recover Restore Save Annotate Attest Edit Harmonize Integrate Link Tag Delete Purge 9/17/2018 DRAFT WORKING DOCUMENT

CPS.3.9 Clinical Decision Support System Guidelines Updates Requirements 1. The system SHALL provide the ability to maintain the clinical content or rules utilized to generate clinical decision support reminders and alerts. 2. The system SHOULD provide the ability to render information that will allow validation that the most applicable version (of the decision support rules) is utilized for the update. The system SHOULD capture the date of update of the decision support rules. 3. The system MAY tag {track} and store {retain} the version used when guidelines are provided in a patient encounter. RED: delete, Blue: insert DRAFT WORKING DOCUMENT 9/17/2018