Objective. The objective of this analysis was to identify a representative set of data elements and associated terminologies used by current CDS systems, so as to inform the data elements and associated terminologies that need to be included in the vMR standard as potential inputs into a CDS engine. In order to facilitate the gathering and analysis of data from a number of disparate CDS systems, we chose to obtain information on atomic data elements using a flat structure, with the intent to address the structural relationships between the data elements at a later stage. Also, CDS engine outputs were not included within the scope of the analysis, as the HL7 vMR project team felt that development of this aspect of the vMR would be better served through the analysis of specific use cases and existing HL7 information models for communicating the results of specific CDS inferences (e.g., for vaccination CDS).
Individuals were eligible to participate in the study if they (i) had knowledge of the data used by an operational CDS system or by a CDS system under active design and development, and/or (ii) were active contributors to the HL7 vMR project. A CDS system was defined using the definition provided above.4
All study participants were invited to be co-authors on this manuscript.
Participant Recruitment. In February 2010, a request for participation was communicated through the HL7 CDS Work Group’s list-serv, and this request asked recipients to forward the email to any potentially interested individuals. The HL7 vMR project team also identified relevant experts and proactively reached out to these individuals. All interested contributors were included as long as the inclusion criteria specified above were met.
Data Collection. Each study participant was asked to provide his or her name, degree(s), institutional affiliation, title, and contact information. For each CDS system with which the study participant had familiarity, the participant was asked to provide the following information: (i) description of system, including purpose, deployment scope, operational status, and any references; (ii) the participant’s relationship with the system (e.g., co-designer; knowledge engineer); (iii) data elements used by the CDS system for making CDS inferences (e.g., procedure code, encounter date); (iv) a definition and example of the data element; (v) if applicable, value sets and terminologies used; (vi) example(s) of data element usage for CDS; and (vii) any comments. To expedite data collection, an initial data entry template was created by the vMR project team based on the draft vMR previously developed by the team. To minimize misinterpretation by the contributors, each data element in the data entry template included a definition, examples, and clarifying comments. In a second round of data collection, the template was revised to include data elements that were not in the original template, and study participants were asked to explicitly identify their usage of these additional data elements.
Data Analysis. As needed, collected data were consolidated through an open, consensus-based process by members of the HL7 vMR project team. For example, equivalent data elements identified by contributors using different terms were merged, either through project conference calls involving the relevant contributors or through direct phone or email communications between the primary author and the relevant contributors. Following consolidation, the data were summarized in terms of data elements used by at least one CDS system, instance examples, the proportion of CDS systems reporting the use of each data element, and use case examples. We provide below the salient aspects of this analysis.