The following are meant to be a laundry list of lessons learned from experiences applying computable clinical pathway methodologies and technologies. The list is not meant to be exhaustive but to capture/document issues so appropriate steps can be taken to mitigate the issues in the future. The list is not ordered. These experiences are the author and do not represent official comments from logica etc
BPM+ Tooling Compatibility (or in compatibility)
Vendor lock in is always a concern. It does not serve the industry well if you can not share artifacts across tooling stacks. Our experiences is that current the tools are about 100% incompatible - the advice from Redhat is to not import but remodel using their tools. The reasons are numerous and some are valid as the standard has been stagnant for some time and no approved extension approach was defined.
If shared artifacts are a real goal - then a set of test and certifications for import/export need to be defined and executed.
BPM+ and CDS Hooks
One of the more popular extensible frameworks is CDS Hooks which is defined as follows
This specification describes a "hook"-based pattern for invoking decision support from within a clinician's workflow. The API supports:
Synchronous, workflow-triggered CDS calls returning information and suggestions
Launching a user-facing SMART app when CDS requires additional interaction
The structure of the hook is not compatible with asynchronous/background applications but the same decisions would be beneficial to asynchronous processes.
The responses from CDS hooks have not been standardized limiting plug and play of CDS hook implementations
TODOS
Introduce and improve support for CDS hooks in BPM+ and similar environments
Standardize and externalize “hook” definitions and semantics
Define profiles for cards to support computable execution of results
improve data required response
Clinical Pathway Rigor
In attempting to automate several documented clinical pathways/best practices - all we have seen do not have enough rigor to be implemented with out some level projection on meanings and inputs.
For instance the following is an exemplar of a portion of a documented pathway modified to illustrate the issues of lack of rigor
if last A1C was high prescribe recommended starting dose of insulin
In the above
A1C observation - how is that located - what codes Loinc etc should be used
What is considered High - while this might be well known by physicians - implementer will not
What is considered starting does ?
A bit more subtle - what does the prescription look like - what recommendations/instructions/cautions should be included