JMIR Publications

ABSTRACT

Background:

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

Objective:

The study develops and deploys the national CDS service for the drug-allergy interaction (DAI) check for healthcare providers that need to introduce the service but lack budget and expertise in Korea.

Methods:

To provide the shared interoperable CDS service, we designed and implemented the system based on the CDS Hooks® specification and HL7® (Health Level 7) FHIR® (Fast Healthcare Interoperability Resources) standard. The study describes the CDS development process. The system development went through the 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 APIs 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 healthcare providers participated in the CDS service. The healthcare providers participated in the service with 1,008,357 DAI checks for 114,694 patients, of which 33,054 cases resulted in a "warning" (3.32%).

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 the practical service development and appeal the benefits of FHIR standardization to policymakers. With the development of various case-specific implementation guides (IGs) using the KR Core IG, the FHIR standards will be distributed nationwide, and more shared interoperable healthcare services will be introduced in Korea.