Immunization Calculation Engine (ICE)
An Open-Source, Configurable Clinical Decision Support System that
Integrates with Any Clinical Information System through a StandardsBased 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
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
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
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
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
Pre-Configured Vaccine Groups
1.
2.
3.
4.
5.
6.
7.
Hep B
Rotavirus
DTP (in progress)
Hib
PCV
Polio (in progress)
MMR
8. Varicella
9. Hep A
10. Meningococcal (in progress)
11. PPSV
12. HPV
13. Influenza
14. H1N1
Documentation of Rules
https://cdsframework.org
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.
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
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.
Thank You!
For more information about ICE, please contact:
Kristen Forney
347-396-2578
kforney@health.nyc.gov
-ORHLN
URL: www.hln.com/ice
Email: ice@hln.com