Fast Healthcare Interoperability Resources, Clinical Quality Language, and Systematized Nomenclature of Medicine—Clinical Terms in Representing Clinical Evidence Logic Statements for the Use of Imaging Procedures: Descriptive Study

BACKGROUND: Evidence-based guidelines and recommendations can be transformed into "If-Then" Clinical Evidence Logic Statements (CELS). Imaging-related CELS were represented in standardized formats in the Harvard Medical School Library of Evidence (HLE). OBJECTIVE: We aimed to (1) describe the representation of CELS using established Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT), Clinical Quality Language (CQL), and Fast Healthcare Interoperability Resources (FHIR) standards and (2) assess the limitations of using these standards to represent imaging-related CELS. METHODS: This study was exempt from review by the Institutional Review Board as it involved no human subjects. Imaging-related clinical recommendations were extracted from evidence sources and translated into CELS. The clinical terminologies of CELS were represented using SNOMED CT and the condition-action logic was represented in CQL and FHIR. Numbers of fully and partially represented CELS were tallied. RESULTS: A total of 765 CELS were represented in the HLE as of December 2018. We were able to fully represent 137 of 765 (17.9%) CELS using SNOMED CT, CQL, and FHIR. We were able to represent terms using SNOMED CT in the temporal component for action ("Then") statements in CQL and FHIR in 755 of 765 (98.7%) CELS. CONCLUSIONS: CELS were represented as shareable clinical decision support (CDS) knowledge artifacts using existing standards-SNOMED CT, FHIR, and CQL-to promote and accelerate adoption of evidence-based practice. Limitations to standardization persist, which could be minimized with an add-on set of standard terms and value sets and by adding time frames to the CQL framework.