Vaccines: IIS Clinical Decision Support Project & Expert Panel

Clinical Decision Support (CDS) Project

The Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to children and adults in the civilian population. Recommendations include: age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. Currently, Immunization Information Systems (IIS) are required to provide healthcare providers with clinical decision support (CDS) tools, such as algorithms and flowcharts, that automatically determine the ACIP-recommended childhood immunization(s) needed when a patient presents for a scheduled immunization.
After ACIP recommendations are published, technical and clinical subject matter experts work to interpret and integrate them into their evaluation and forecasting/CDS engines. Today, the process of incorporating new ACIP recommendations into the various engines happens in relative silos amongst several different IIS, EHRs, and other health systems. As a result, interpretations of the scientific ACIP recommendations vary. New ACIP schedule changes are also currently communicated only through scientific language, in publications like the Morbidity and Mortality Weekly Report (MMWR) and the Epidemiology and Prevention of Vaccine-Preventable Diseases ("The Pink Book"). The translation of that scientific language into technical logic that can be processed within CDS engines is a time-consuming process.

CDS Project

In an effort to harmonize CDS tools and improve the timeliness of updates to their schedules, the American Recovery and Reinvestment Act (ARRA) Section 317 Immunization program appropriated funds to the Immunization Information System Support Branch (IISSB) for a CDS Project including the creation of an expert panel. The expert panel will help improve the accuracy and consistency of clinical decision support by bridging the gap between scientific ACIP recommendations and the IT world of CDS engines.

CDC Expert Panel

The expert panel consists of three workgroups, each tasked with a unique objective:
Logic Specification – This workgroup will develop a framework for use in automated, electronic systems and elsewhere to improve the clarity, accuracy, and consistency of on-going immunization forecasting and evaluation. Their objectives are:

• Create a standardized CDS logic representation of ACIP recommendations that allows for broad implementation and effective usage across IIS and other health information systems
• Define the format to be used for the standardized communication of ACIP recommendations
• Leverage a new formalized liaison relationship with ACIP and CDC SMEs to assure computability of recommendations

To date the logic specifications group has developed a domain model which serves as foundation for the project. It includes a common vocabulary of terms and definitions, a domain diagram, and is a visual representation of the project focus. They have also developed use cases and begun work on business rules, activity diagrams and a high-level process model of the project. This group will continue to finalize the use cases and diagrams and work on developing evaluation and forecasting tools.

Process, Communication and Sustainability (PCSP) – This workgroup seeks to establish a relationship and develop an efficient, timely, and effective communication process among ACIP, CDC SMEs, and those maintaining CDS engines. Their objectives are:

• Establish a formalized liaison relationship with ACIP and CDC SMEs to assure computability in recommendations
• Define an on-going process for the standardized communication of ACIP recommendations and related logic
• Provide a means for those maintaining CDS engines to obtain clarification regarding the ACIP schedule

The workgroup has developed a survey to investigate current ACIP interactions and help determine how logic specifications will be updated and developed in the future. The survey was distributed electronically to IIS program grantees, HIEs, EHR vendors, and IIS vendors. PCSP has also identified an ACIP liaison who will address questions from the panelists and support current and future process recommendations of the project.
Validation and Testing – This workgroup will develop testing tools that can validate the framework and be flexible enough to provide for changes in the ACIP recommendations. Their objectives are:

• Create test cases and expected results to extensively test standardized CDS logic representation in compliance with the ACIP schedule
• Leverage the new formalized liaison relationship with ACIP and CDC SMEs to assure accuracy of test cases and expected results
• Developing a plan for maintaining the test cases and expected results

The Validation and Testing workgroup has collected and is currently evaluating relevant immunization test cases from multiple stakeholders to identify current standards in various programs. They have created a template to consolidate the current test cases and transpose them into a standard format to identify best practices among them and evolve those into new test cases which support the project logic specifications. The workgroup will also develop a maintenance strategy for the testing tools so they can evolve with future ACIP schedule recommendations and changes.

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For information on EHRs and the Immunization Information Systems Support Branch, see EHR-IIS Interoperability Expert Panel Project.
Vaccines: IIS Clinical Decision Support Project & Expert Panel