Using Standards to share Technology: FHIR CQL project

Clinical Practice Guidelines (CPG), meant to express best practices in healthcare, are commonly presented as narrative documents communicating care processes, decision making, and clinical case knowledge. These narratives lack the specificity and conciseness in their use of language to unambiguously express quality clinical recommendations. This study is proof of concept for NICE recommendations to be represented in computable format (FHIR, CDS, CQL, BPM+). Healthcare domain-specific languages (DSL) such as FHIR and CQL to describe a CPG provide a standardized, shareable, computable artefact that leaves little room for misinterpretation or ambiguity. The suggested solution is based on reporting the implementation and evaluation of FHIR services with CQL emerging standards in three use cases.

1. Build a HAPI FHIR server and generate a synthetic patient data set.
2. Create 3 use cases for different health conditions
a. Use the mock data to test the implementation of the server and the implementation of the NICE guidelines based on these scenarios.
b. Write CQL queries on these data, implementing the NICE guidelines.
3. Conduct preliminary data analysis and seek NICE and RDS advice to inform study design for NIHR grant application.
4. Write up the results of the use cases and submit for publication.

We developed use cases and synthetic data, and based on those we then developed purposeful CQL reusable libraries to showcase the possibilities of multidisciplinary teams and how CQLs could be best used to support clinical decision making.