Towards a Unified Framework of Public Health Knowledge for Clinical Decision Support

The application of alerting algorithms and immunization guidelines are examples of two clinical decision support services through which public health (PH) can provide information and population-based guidance for clinicians.  Alerting is one of the traditional responsibilities of PH agencies, whereas real-time computerized decision support, including immunization decision support, has primarily been addressed by those developing clinical systems. We explored both use cases in the context of three different implementation strategies using available technical frameworks and HITSP-identified standards. This work uses as a foundation, previous work demonstrated at annual Healthcare Information Management and Systems Society (HIMSS) meetings in 2006-2008, and at the 2008 PHIN meeting, in which the Integrating the Healthcare Enterprise (IHE) Showcase provided a venue to demonstrate standards-based interoperable information exchanges. The alerting scenario at the IHE Showcase included demonstration of three HITSP-identified standards for public health alerting, Retrieve Forms for Data Capture Transaction Package (T50); Retrieval of Medical Knowledge Transaction (T81); and Emergency Message Distribution Element Transaction (T63). The immunization scenario included use of the Immunization Content Profile (IS) in a service oriented architecture environment, using a vendor supplied service for decision support. Our work compared each use case with each available standard systematically, and highlighted the way standards support tailored decision support in these areas. Commonalities identified between the use cases suggest that a unified approach to knowledge management and retrieval is feasible. Such a unified approach may require additional specifications such as a framework for Immunization Decision Support, the HL7 3 Continuity of Care Document, and other content and information exchange protocols for both decision support and alerting. In this presentation we will present our findings as we explored the use of the existing frameworks for these two use cases, and discuss progress towards a single knowledge framework to support these and other PH use cases.