1. Immunization Calculation Engine (ICE)
Public Health Informatics Conference 2014
Immunization Calculation Engine (ICE)
An Open-Source, Configurable Clinical Decision Support System that Integrates with Any Clinical Information System
through a Standards-Based Web Service Interface
– Utilized for Immunizations
Michael Suralik, HLN Consulting, LLC
Regina Austin, HLN Consulting, LLC
April 29, 2014

2. Agenda Clinical Decision Support Services The ICE Software System
Integrating ICE with Clinical Information Systems

3. Benefits of CDS Improved quality of care Better health outcomes
Avoidance of errors and adverse of events
Improved efficiency
Reduced costs
Increased provider/patient satisfaction

4. CDS is Not Widely Available
CDS is complex
CDS capabilities have been tightly coupled with specific institutions and health IT systems
Re-using CDS implemented elsewhere is difficult

5. The Need
Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health

6. OpenCDS www.opencds.org
Collaborative project, led by Dr. Kensaku Kawamoto at the University of Utah
A software platform and toolkit for developers implementing CDS services
Open source 6 6

7. ICE Project 7

8. The ICE Project
Collaboration of public health agencies, academic researchers, and a private firm
Leveraged OpenCDS to implement CDS for immunizations (aka “immunization forecasting”)
Needed by providers and public health agencies
One strategy is to collaborate with other organizations that are trying to solve the same problem.
Pool your resources and jointly develop a shared solution.
That is precisely the approach that the ICE team has taken to implement the Immunization Calculation Engine.
The New York City CIR, HLN, Alabama, and the OpenCDS Team have been working together closely for two years to produce ICE.

9. ICE Software System ICE Web Service CDS Administration Tool (CAT)
Provides immunization forecasting to clinical systems through a web service interface
Supports routinely administered vaccine groups, from infant to adult
CDS Administration Tool (CAT)
Web-based tool enables non-technical subject matter experts (SMEs) to manage ICE
Human readable rules

10. ICE Web Service Inputs: Outputs:
DOB, gender, immunization history, disease immunity
Immunization schedule identifier, date of evaluation
Outputs:
Validity of immunization history + reasons
Immunization recommendations + reasons 10

11. Sample ICE Deployment 11 11

12. Software Architecture
ICE/OpenCDS
Tomcat or JBoss AS (aka “WildFly”)
JBoss Drools (rule engine/database)
JBoss jBPM (process/workflow)
HL7 vMR (data model)
CAT
JavaServer Faces (GUI)
Enterprise JavaBeans (business logic)
Apache Derby JVM (database)

13. Ease of Adoption and Integration with Clinical Information Systems13

14. Open-Source ICE built with only open-source software
No dependencies on any commercial software
Released under a standard open-source license
GNU Lesser General Public License version 3 (LGPL v3)
Any system (even proprietary systems) may use/modify/integrate with ICE at no cost
Any modifications to ICE software must be shared
No warranty
More prominently state that IIS can acquire this at no cost

15. Flexible Deployment Options
Java-based system runs on variety of hardware/operating system platforms
Deploys on same or different server as the client system
Can be adapt for any IIS in the country 15

16. Standards-Based Interface
Attribute of ICE
Conforms to Relevant Technical Standard
Messaging framework
Simple Object Access Protocol (SOAP)
Web Service interface
Decision Support Service (DSS)
– an HL7 & OMG standard –
Data model
Virtual Medical Record (vMR)
– an HL7 standard –
Virtual_Medical_Record_(vMR)

17. ICE Wiki

18. Technical Documentation of ICE’s Standards-Based Interface
20 seconds

19. Production Use of ICE by an EHR System
eClinicalWorks (eCW) v10 uses ICE to deliver evaluations and recommendations
Integrated by eCW developers, with minimal support from ICE team
No modifications to the default configuration
ICE is hosted by eCW at central location

20. Summary of the ICE Software System
Freely available
Standards-based
Easily integrates with other systems
Maintainable by non-developers
Collaboratively developed
Transparent
Can be leveraged for other types of CDS

21. Leverage Our Work for Other Types of CDS
Drug interaction/allergy (warning)
Abnormal lab result (alert)
Ordering of appropriate lab test (critique)
Disease management (reminder)
Treatment/care plans (recommendation)
Automated redaction of sensitive data from clinical documents

22. Clinical Decision Support Administration Tool (CAT)22

23. Clinical Decision Support Administration Tool (CAT)
Graphical user interface
Non-technical SMEs may configure ICE
Create, edit, delete…
Vocabulary and code sets
Schedule parameters
Rules
Test cases
Can expand to other clinical domains

24. Code System Editor 24

25. Vaccine Editor 25

26. Vaccine Series Editor

27. Rule Editor - Example: Varicella Rule for Patients Born before 01/01/1980
20 seconds

28. Test Editor (Test Case View)
Immediately rerun failed test

29. Test Editor (Test Results View)
Immediately rerun failed test

30. For More Information about ICE…
Mike Suralik OR
URL: