Immunization Calculation Engine (ICE) Public Health Informatics Conference 2014 Immunization Calculation Engine (ICE) An Open-Source, Configurable Clinical Decision Support System that Integrates with Any Clinical Information System through a Standards-Based Web Service Interface – Utilized for Immunizations Michael Suralik, HLN Consulting, LLC Regina Austin, HLN Consulting, LLC April 29, 2014

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

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

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

The Need Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health

OpenCDS www.opencds.org Collaborative project, led by Dr. Kensaku Kawamoto at the University of Utah A software platform and toolkit for developers implementing CDS services Open source 6 6

ICE Project 7

The 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 One strategy is to collaborate with other organizations that are trying to solve the same problem. Pool your resources and jointly develop a shared solution. That is precisely the approach that the ICE team has taken to implement the Immunization Calculation Engine. The New York City CIR, HLN, Alabama, and the OpenCDS Team have been working together closely for two years to produce ICE.

ICE Software System ICE Web Service CDS Administration Tool (CAT) 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

ICE Web Service Inputs: Outputs: DOB, gender, immunization history, disease immunity Immunization schedule identifier, date of evaluation Outputs: Validity of immunization history + reasons Immunization recommendations + reasons 10

Sample ICE Deployment 11 11

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)

Ease of Adoption and Integration with Clinical Information Systems 13

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 More prominently state that IIS can acquire this at no cost

Flexible Deployment Options Java-based system runs on variety of hardware/operating system platforms Deploys on same or different server as the client system Can be adapt for any IIS in the country 15

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)

ICE Wiki www.cdsframework.org

Technical Documentation of ICE’s Standards-Based Interface 20 seconds

Production Use of ICE by 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

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

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

Clinical Decision Support Administration Tool (CAT) 22

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

Code System Editor 24

Vaccine Editor 25

Vaccine Series Editor

Rule Editor - Example: Varicella Rule for Patients Born before 01/01/1980 20 seconds

Test Editor (Test Case View) Immediately rerun failed test

Test Editor (Test Results View) Immediately rerun failed test

For More Information about ICE… Mike Suralik 856-751-1094 suralik@hln.com OR URL: www.hln.com/ice Email: ice@hln.com