1. 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 Public Health Informatics Conference April 30, 2014 Kristen Forney, MPH New York City Department of Health and Mental Hygiene, Bureau of Immunization, Citywide Immunization Registry

2. Need From IIS Perspective CDS rules are complex ACIP rules can be ambiguous or do not address specific scenarios ACIP recommendations change regularly Comprehensive testing required after each change to a CDS engine; significant effort required for manual testing IIS often have limited IT staff/developers Duplicative effort with multiple IIS/organizations each maintaining a CDS engine

3. History of ICE Collaboration New York City Citywide Immunization Registry (CIR) was looking to replace their existing decision support engine with something more streamlined and flexible HLN Consulting, CIR’s long-time provider of health IT consulting services, was asked to implement ICE; OpenCDS was selected as the platform and toolkit for implementing ICE Subject Matter Expert (SME) Workgroup was formed to develop rules and test cases Alabama Department of Health (ADPH) volunteered to be part of the Subject Matter Expert (SME) Workgroup, as they were also looking to replace their CDS engine

4. ICE Collaborators Open CDS Team – Made enhancements to OpenCDS Platform to support immunization clinical decision support HLN – Development of ICE Web Service and CDS Administration Tool (CAT) Subject Matter Expert Workgroup – 12 people from HLN, CIR, ADPH – Mix of public health immunization experts (MDs, MPHs), nurse, pediatrician, business analysts and software developers – Responsible for ICE rules and test cases

5. Goals of the ICE SME Workgroup Clearly document rules for each vaccine group in a standardized format Document the rules such that: – Subject matter experts can manage them with little to no intervention from software developers – Other IIS (or organizations) can easily modify rules to suit their needs Use clinical knowledge and expertise of subject matter experts to reconcile areas of ambiguity in the ACIP rules Develop suites of comprehensive, automated test cases

6. Pre-Configured Vaccine Groups 1.Hep B 2.Rotavirus 3.DTP (in progress) 4.Hib 5.PCV 6.Polio (in progress) 7.MMR 8.Varicella 9.Hep A 10.Meningococcal (in progress) 11.PPSV 12.HPV 13.Influenza 14.H1N1

7. Documentation of Rules https://cdsframework.org

8. CDC’s CDSi Project CDC convened a panel of experts to develop “a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines” The CDSi group developed a logic specification with supporting data and test cases, but did not implement these logic specifications in a CDS engine. The ICE group used the resources and test cases developed by the CDSi to inform the vaccine series rules and compare test case results.

9. ICE and CDSi Collaboration NYC CIR staff and HLN staff participated in the CDSi workgroup – Phase I (April 2011 – November 2012) – Phase II (February 2014 – January 2015) Imported CDSi’s 700+ test cases into the ICE testing tool Documented and/or resolved observed differences Ongoing discussions with leaders of the CDSi project ICE and CDSi rules are closely aligned and in many cases are converging

10. Conclusion Collaboration of a diverse group of subject matter experts led to a more thorough examination of the rules and a better final product. Implementation of the rules into a working CDS engine required complete and unambiguous rules; considerable time and effort was required to ensure that all scenarios were covered. Collaboration will continue to grow as more organizations implement and contribute to ICE.

11. Thank You! Kristen Forney 347-396-2578 kforney@health.nyc.gov -OR- HLN URL: www.hln.com/icewww.hln.com/ice Email: ice@hln.com For more information about ICE, please contact: