Clinical Decision Support for Immunization (CDSi)

Immunization clinical decision support (CDS), more commonly referred to as evaluation and forecasting, is an automated process that determines the recommended immunizations needed for a patient and delivers these recommendations to the healthcare provider. Health Information Systems (HIS) – which can include Health Information Exchanges (HIEs), Immunization Information Systems (IIS) and Electronic Health Records (EHRs) – provide healthcare providers with immunization evaluation and forecasting tools designed to automatically determine the recommended childhood immunizations needed when a patient presents for vaccination. These recommendations are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is a federal advisory committee responsible for providing expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) and the Secretary of the U.S. Department of Health and Human Services (DHHS) on use of vaccines and related agents for control of vaccine-preventable disease in the United States. Recommendations include age for vaccine administration, number of doses, dosing interval, and precautions and contraindications.

After ACIP recommendations are published, technical and clinical subject matter experts (SMEs) work to interpret and integrate them into their evaluation and forecasting engines. New ACIP schedule changes are currently communicated only through clinical language, in publications like the Morbidity and Mortality Weekly Report (MMWR) and the Epidemiology and Prevention of Vaccine-Preventable Diseases ("The Pink Book"). The translation of that clinical language into technical logic that can be processed within evaluation and forecasting engines is a time-consuming and complex process that happens mostly independently within the different HIS. Due to the challenge of interpreting clinically-written ACIP recommendations, CDS engine outputs often vary and do not always match the expectations of clinical SMEs.

CDSi Logic Specification and Supporting Data

Clinical Decision Support for Immunization (CDSi): Logic Specification for ACIP Recommendations, version 1.6 [1.71 MB, 96 pages] UPDATED MAR 2014
Eight chapters, including an executive summary, and 5 appendices
Supporting Data Version 1.6 [750 KB] UPDATED MAR 2014
These supporting data are the attributes and specific values required to support evaluation and forecasting as defined in the Logic Specification.

The CDSi Logic Specification provides a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines. It captures ACIP recommendations in an unambiguous manner and improves both the uniform representation of vaccine decision guidelines, as well as the ability to automate vaccine evaluation and forecasting.

The target audience for the Logic Specification for ACIP Recommendations includes business and/or technical implementers of immunization CDS engines. These implementers may support any system with an immunization evaluation and forecasting engine, including but not limited to IIS.

The Logic Specification was developed to be as implementation-neutral as possible to support those currently with or without complete evaluation and forecasting engines as they:

Refine, extend, or develop their implementation;
Clarify their understanding of immunization rules; and
Troubleshoot and verify correct implementation of immunization rules.

Testing Methodology and Test Cases

CDSi Test Cases User Guide, version 1.1 [26 pages] UPDATED JUL 2013
Test Cases
- CDSi Test Cases, version 1.4 UPDATED JAN 2014
- CDSi Test Cases, version 1.4 [1.1 MB, 9 pages] (for Section 508 access) UPDATED JAN 2014

The CDSi expert panel developed a testing methodology to extensively test the compliance of CDS logic representation within CDS engines with the ACIP recommendations. The panel also created test cases and expected results which can be processed against an immunization evaluation and forecasting engine to validate or test its algorithm against the Logic Specification.

Web-based Training

To learn about key concepts of the CDSi Logic Specification, Supporting Data, and Testing Methodology, see the web-based training courses.

User Support

Please email any questions to: nipinfo@cdc.gov.

Additional Resources

Clinical Decision Support for Immunization (CDSi) Mini Guide

[8 pages] NEW JAN 2013
A summary of the efforts to harmonize the outcomes of existing CDS tools by: increasing the accuracy and consistency of immunization evaluation and forecasting, improving the ease of developing and maintaining immunization CDS products and improving the process of updating CDS logic with new and/or changed ACIP recommendations.