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
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Clinical Decision Support Services
The ICE Software System
Integrating ICE with Clinical Information Systems
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Benefits of CDS
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Improved quality of care
Better health outcomes
Avoidance of errors and adverse of events
Improved efficiency
Reduced costs
Increased provider/patient satisfaction
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CDS is Not Widely Available
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CDS is complex
CDS capabilities have been tightly coupled with
specific institutions and health IT systems
Re-using CDS implemented elsewhere is
difficult
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The Need
Application-independent CDS
resources that can be efficiently
leveraged by diverse healthcare
systems and health IT settings to
improve patient health
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OpenCDS
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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
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ICE Project
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The ICE Project
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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
ICE Software System
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ICE Web Service
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Provides immunization forecasting to clinical systems
through a web service interface
Supports routinely administered vaccine groups,
from infant to adult
CDS Administration Tool (CAT)
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Web-based tool enables non-technical subject matter
experts (SMEs) to manage ICE
Human readable rules
ICE Web Service
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Inputs:
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DOB, gender, immunization history, disease immunity
Immunization schedule identifier, date of evaluation
Outputs:
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Validity of immunization history + reasons
Immunization recommendations + reasons
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Sample ICE Deployment
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Software Architecture
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ICE/OpenCDS
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Tomcat or JBoss AS (aka “WildFly”)
JBoss Drools (rule engine/database)
JBoss jBPM (process/workflow)
HL7 vMR (data model)
CAT
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JavaServer Faces (GUI)
Enterprise JavaBeans (business logic)
Apache Derby JVM (database)
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Ease of Adoption and Integration
with Clinical Information Systems
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Open-Source
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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)
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Any system (even proprietary systems) may
use/modify/integrate with ICE at no cost
Any modifications to ICE software must be shared
No warranty
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Flexible Deployment Options
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Java-based system runs on variety of
hardware/operating system platforms
Deploys on same or different server as the client
system
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Standards-Based Interface
Attribute of Conforms to Relevant
ICE
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)
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ICE Wiki
www.cdsframework.org
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Technical Documentation of
ICE’s Standards-Based Interface
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Production Use of ICE
by an EHR System
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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
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Summary of the ICE Software System
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Freely available
Standards-based
Easily integrates with other systems
Maintainable by non-developers
Collaboratively developed
Transparent
Can be leveraged for other types of CDS
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Leverage Our Work
for Other Types of CDS
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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
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Clinical Decision Support
Administration Tool
(CAT)
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Clinical Decision Support
Administration Tool (CAT)
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Graphical user interface
Non-technical SMEs may configure ICE
Create, edit, delete…
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Vocabulary and code sets
Schedule parameters
Rules
Test cases
Can expand to other clinical domains
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Code System Editor
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Vaccine Editor
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Vaccine Series Editor
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Rule Editor - Example: Varicella Rule
for Patients Born before 01/01/1980
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Test Editor (Test Case View)
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Test Editor (Test Results View)
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For More Information about ICE…
Mike Suralik
856-751-1094
suralik@hln.com
OR
URL: www.hln.com/ice
Email: ice@hln.com
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