Shared Interoperable Clinical Decision Support Service for Drug-Allergy Interaction Checks: Implementation Study

Sungwon Jung; Sungchul Bae; Donghyeong Seong; Ock Hee Oh; Yoomi Kim; Byoung-Kee Yi

doi:10.2196/40338

Shared Interoperable Clinical Decision Support Service for Drug-Allergy Interaction Checks: Implementation Study

JMIR Med Inform. 2022 Nov 10;10(11):e40338. doi: 10.2196/40338.

Authors

Sungwon Jung¹, Sungchul Bae², Donghyeong Seong¹, Ock Hee Oh³, Yoomi Kim⁴, Byoung-Kee Yi⁵

Affiliations

¹ Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.
² Data Science Research Institute, Samsung Medical Center, Seoul, Republic of Korea.
³ FirstDIS Ltd, Seoul, Republic of Korea.
⁴ Electronic Medical Records System Certification Criteria Development Department, Korea Health Information Service, Seoul, Republic of Korea.
⁵ Department of Artificial Intelligent Convergence, Kangwon National University, Gangwon-do, Republic of Korea.

PMID: 36355401
PMCID: PMC9693697
DOI: 10.2196/40338

Abstract

Background: Clinical decision support (CDS) can improve health care with respect to the quality of care, patient safety, efficiency, and effectiveness. Establishing a CDS system in a health care setting remains a challenge. A few hospitals have used self-developed in-house CDS systems or commercial CDS solutions. Since these in-house CDS systems tend to be tightly coupled with a specific electronic health record system, the functionality and knowledge base are not easily shareable. A shared interoperable CDS system facilitates the sharing of the knowledge base and extension of CDS services.

Objective: The study focuses on developing and deploying the national CDS service for the drug-allergy interaction (DAI) check for health care providers in Korea that need to introduce the service but lack the budget and expertise.

Methods: To provide the shared interoperable CDS service, we designed and implemented the system based on the CDS Hooks specification and Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The study describes the CDS development process. The system development went through requirement analysis, design, implementation, and deployment. In particular, the concept architecture was designed based on the CDS Hooks structure. The MedicationRequest and AllergyIntolerance resources were profiled to exchange data using the FHIR standard. The discovery and DAI check application programming interfaces and rule engine were developed.

Results: The CDS service was deployed on G-Cloud, a government cloud service. In March 2021, the CDS service was launched, and 67 health care providers participated in the CDS service. The health care providers participated in the service with 1,008,357 DAI checks for 114,694 patients, of which 33,054 (3.32%) cases resulted in a "warning."

Conclusions: Korea's Ministry of Health and Welfare has been trying to build an HL7 FHIR-based ecosystem in Korea. As one of these efforts, the CDS service initiative has been conducted. To promote the rapid adoption of the HL7 FHIR standard, it is necessary to accelerate practical service development and to appeal to policy makers regarding the benefits of FHIR standardization. With the development of various case-specific implementation guides using the Korea Core implementation guide, the FHIR standards will be distributed nationwide, and more shared interoperable health care services will be introduced in Korea.

Keywords: CDS Hooks; Fast Healthcare Interoperability Resources; Health Level 7; clinical decision support; drug-allergy interaction; interoperability.

©Sungwon Jung, Sungchul Bae, Donghyeong Seong, Ock Hee Oh, Yoomi Kim, Byoung-Kee Yi. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 10.11.2022.