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.

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CDS Expert Panel

The CDS Expert Panel consists of 40 industry experts representing the CDC Public Health Informatics and Technology Program Office (PHITPO), the American Immunization Registry Association (AIRA), the American Academy of Pediatrics (AAP), the Indian Health Service (IHS), IIS vendors, Electronic Health Record (EHR) vendors, IIS programs, and several academic institutions. Formed by IISSB in April 2011, the panel is divided into three sub-groups, each tasked with unique objectives:

• Logic Specification Panel (LSP),
• Process, Communication and Sustainability Panel (PCSP), and
• Validation and Testing Panel (VTP)

Logic Specification Panel (LSP)

The LSP is focused on developing a logic specification that captures ACIP recommendations in an unambiguous manner and improves both the uniform representation of vaccine decision guidelines as well as the ability to automate vaccine evaluation and forecasting.  The Logic Specification for ACIP Recommendations will provide a single, authoritative, implementation-neutral foundation for development and maintenance of clinical decision support engines. It will increase the accuracy and consistency of forecasting and evaluation across the IIS community and improve the timeliness of IIS accommodation of new or changed rules. The artifacts contained in the logic specification include business rules, decision tables, supporting data tables, use cases, and activity diagrams designed to represent the ACIP General Recommendations and immunization evaluation and forecasting processes in a standardized, computable manner.

The work of this panel is not limited to IIS alone. The Logic Specification for ACIP Recommendations can be utilized by any system with an immunization evaluation and forecasting engine, including but not limited to other EHR systems and Health Information Exchanges (HIEs). The Logic Specification for ACIP recommendations is targeted to be released to the public in September 2012.

Process, Communication and Sustainability Panel (PCSP)

To ensure the long-term viability of the Logic Specification, the PCSP is working to establish a relationship and develop an efficient, timely, and effective communication process among ACIP, CDC SMEs, and those maintaining CDS engines. The group has identified an ACIP liaison who addresses questions from the panelists and supports recommendations of the project. The group has formulated a strategic two-way communication plan and training plan that will support the initial release of the Logic Specification to the public as well as ensure effective information dissemination and knowledge-building over time. The long-term communication process will ensure a means for those maintaining CDS engines to obtain clarifications regarding the ACIP schedule as required.

Validation and Testing Panel (VTP)

The VTP is developing a collection of representative test cases and expected results which will be available for download and use by CDS implementers and testers to validate their evaluation and forecasting algorithms. The VTP used a methodology of systematically creating test cases focusing on the boundaries between valid and not valid vaccine doses administered. Together with the logic specification, these test cases can be used to exercise and improve the accuracy of local evaluation and forecasting engines. The methodology used by the VTP can serve as insight and a best practice guide in creating additional test cases in local environments.

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Existing Resources

An immunization scheduling algorithm, originally developed by the National Immunization Program (now called the National Center for Immunization and Respiratory Diseases) in 2002, is available for use in immunization registries. The software has been incorporated into an ActiveX object, so it can be used on any platform that supports this type of component.

Until the final recommendations are available, we encourage you to access the following resources related to the 2002 algorithm.

1. Programmers' Guide to the Automated Immunization Evaluation Process
2. Algorithm Parameters Data File [602KB]
3. Algorithm Parameters Text File [56KB]
4. Test Cases Data File [46KB, 2 pages] Last updated 12/1/04
5. Test Cases Text File

See EHR-IIS Interoperability Expert Panel Project for more information on other Expert Panel Project activities.

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