Ensuring that children receive recommended vaccines is an integral aspect of pediatric preventive care. However, as the immunization schedule and the number of vaccines continue to grow, it becomes more challenging for pediatricians to monitor and consistently adhere to the constantly changing guidelines. Computer-based clinical decision support (CDS) can be an effective strategy for improving the quality of care. However, many clinical healthcare systems either lack CDS or are slow to keep their CDS in line with the changing guidelines. A public-private partnership of healthcare and information technology experts are collaborating to provide a solution to this problem through the development of a free, open-source immunization CDS system that can be integrated with EHR systems and other healthcare systems and can be maintained by non-developers.
Recent development of OpenCDS, an open-source, standards-based, service-oriented framework designed to support the delivery of CDS in any healthcare domain has made CDS more accessible to implementers and users of clinical healthcare systems. A public-private partnership of healthcare and information technology experts is utilizing OpenCDS (http://www.opencds.org) to implement the Immunization Calculation Engine (ICE), a state-of-the-art, open-source immunization evaluation and forecasting software system that evaluates a patient's immunization history and also generates the appropriate immunization recommendations for the patient. Current collaborators in the ICE initiative include the departments of health for a large municipality in the Northeast and for a state in the South, a major university in the West, and a national firm that provides healthcare informatics consulting services.
An initial implementation of the ICE system has been completed and is undergoing continuous enhancement. An overview of the OpenCDS platform and Immunization Calculation Engine will be presented, along with a demonstration of ICE and its supporting tools. Subject matter experts from multiple organizations are in the process of configuring ICE to adhere to the standard recommendations that are established by the Advisory Committee on Immunization Practices (ACIP) (http://www.cdc.gov/vaccines/recs/acip/) and endorsed by the American Academy of Pediatrics. However, any subject matter expert will be able to use the RuleManager’s innovative graphical user interface to modify the immunization rules to accommodate changes in the ACIP guidelines or unique requirements in a particular clinical setting. In addition, the TestManager enables users to define and save test cases and then automatically run the full battery of tests whenever the rules are changed. ICE is designed to be a module that easily integrates with and complements third party clinical systems.
ICE represents a promising example of the potential for open-source, standards-based CDS resources to be collaboratively developed and maintained so as to efficiently enable advanced CDS across multiple organizations. Collaborations are being actively explored with multiple other jurisdictions and healthcare provider organizations.