Immunization Calculation Engine (ICE)

Description

The Immunization Calculation Engine (ICE) is an immunization evaluation and forecasting system, whose default immunization schedule supports all routine childhood, adolescent, and adult immunizations based on the recommendations of the Advisory Committee on Immunization Practices (ACIP). ICE evaluates a patient's immunization history and generates the appropriate immunization recommendations for patients. ICE is free and open-source available through https://cdsframework.atlassian.net/wiki/spaces/ICE/overview.

Artifact Type
Version
0.1.0
Status
Experimental
False

Artifact Creation and Usage

Contributors

A collaborative partnership of public health experts and information technology experts are from a variety of organizations.

Work on ICE is managed by representatives from the following organizations:

  • Subject Matter Workgroup
  • Review Board
    • WorldVistA
    • Public Health Informatics Institute
    • Michigan Department of Health and Human Services
    • American Immunization Registry Association
    • New York City Department of Health and Mental Hygiene
    • Office Practicum
    • Department of Veterans Affairs
    • Vanderbilt University Medical Center
  • Steward and Development Organization.
    • HLN Consulting
License
IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.
Copyrights

2014 New York City Department of Health and Mental Hygiene, Bureau of Immunization.  Contributions by HLN Consulting, LLC.

This program is free software: you can redistribute it and/or modify it under the terms of the GNU Lesser General Public License as published by the Free Software Foundation, either version 3 of the License, or (at your option) any later version. You should have received a copy of the GNU Lesser General Public License along with this program. If not, see <http://www.gnu.org/licenses/> for more details.

The above-named contributors (HLN Consulting, LLC) are also licensed by the New York City Department of Health and Mental Hygiene, Bureau of Immunization to have (without restriction, limitation, and warranty) complete irrevocable access and rights to this project.

This program is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; THE SOFTWARE IS PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE COPYRIGHT HOLDERS, IF ANY, OR DEVELOPERS BE LIABLE FOR ANY CLAIM, DAMAGES, OR OTHER LIABILITY OF ANY KIND, ARISING FROM, OUT OF, OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE.

Additional licensure and copyright information available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/23920690/Open-Source+License

Implementation Details
Engineering Details

Each release of ICE is accompanied with the following information and available through the link: https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/18972704/Download:

  • Binary Distribution
  • Release Notes
  • Directions for Installing ICE
  • Implementation Guide for Integration with ICE

The ICE Implementation Guide provides users with details on how to implement and integrate with ICE.

Users may also build ICE from Source Code described in the Engineering Details section. Also accessible through the following link: https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/18972686/Building+ICE+from+Source+Code

Most deployers of ICE will want to simply install the most recent binary distribution of ICE that has been released through this website by following the instructions for Installing ICE at: https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/18972687/Installing+ICE

Developers interested in building an ICE executable from the source code may do so by following the instructions below.

  • Download the ICE source code from the bitbucket repository at: https://bitbucket.org/cdsframework/ice
  • Follow the directions in the README.ICE file.
  • A deployable WAR will be created in opencds-parent/opencds-decision-support-service/target/.
  • To deploy the WAR, modify the configuration files, and interact with the ICE web service, follow the instructions for Installing ICE.

Sample client source code is available in Java and .NET. See the installation instructions for more information.

Logic Files

The binary distribution for the most recent release of the Immunization Calculation Engine (ICE) is available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/18972704/Downloads

Alternatively, instructions to build an ICE executable from the source code are available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/18972686/Building+ICE+from+Source+Code

Technical Files and Supporting Documents

The following technical files and supporting documents are available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/18972704/Downloads

  • Binary distribution release notes
  • Directions for installing ICE
  • Implementation guide for integrating with ICE
  • Virtual medical record (vMR) Domain Analysis Model, Release 1
  • vMR 1.0 XML Schema Definition files
  • ICE Web Service WSDL

Test Sample Patient Data

A simple application, called "ICE Client", allows submission of sample patient data to the ICE Web Service to see the evaluations and recommendations that the ICE Web Service returns. The primary purpose of the application is to make it easier for the owners and implementers of health information systems to test and/or integrate with the ICE Web Service.
The ICE Client application and documentation are available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/27820034/Try+ICE+by+Using+the+ICE+Client+App
 

Repository Information
Approval Date
Publication Date
Last Review Date
Knowledge Level
1. NARRATIVE 2. SEMI-STRUCTURED 3. STRUCTURED 4. EXECUTABLE

Executable code that is interpretable by a CDS system at a local level. This will vary for each particular site

Purpose and Usage
Purpose

ICE evaluates immunization history and provides recommendations for delivery of all routine childhood, adolescent, and adult immunizations that may be due now or in the future. The following factors are considered as part of the logic for recommendation:  the age when the vaccine should be given, the number of doses, the time between doses, and certain disease immunities or disease history. 

Intended Population

All patients.

Usage

Intended for providers who vaccinate patients in varied inpatient and outpatient settings, including hospitals, provider offices, pharmacies, schools, community health centers, and public health clinics.

Cautions

The ICE default immunization schedule is intended to support routine vaccination recommendations.

The ACIP recommendations and ICE default immunization schedule are dynamic. The field of immunization is marked by constant change, including licensing of new vaccines, new vaccination recommendations, and new findings about how vaccines work and their adverse events. ACIP holds three meetings each year to make vaccine recommendations. ICE is continually updated to incorporate the latest ACIP recommendations.

The latest ICE version and documentation are available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/23494658/Documentation

A comprehensive list of ACIP Vaccine Recommendations and Guidelines is available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html

Supporting Evidence
Source Description

The Immunization Calculation Engine (ICE) default immunization schedule, which is based on Advisory Committee on Immunization Practices (ACIP) recommendations and informed by the work of the Center for Disease Control and Prevention's Clinical Decision Support for Immunization (CDSi) project, is the result of a collaborative effort by immunization and information technology experts. This group of subject matter experts has met regularly since September 2011 to document the default immunization schedule rules and create the corresponding test cases.

ACIP comprises medical and public health experts who develop recommendations on the use of vaccines in the civilian population of the United States. The recommendations stand as public health guidance for safe use of vaccines and related biological products. ACIP was established under Section 222 of the Public Health Service Act (42 U.S.C. § 2l7a).

References

A comprehensive and updated list of the Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations and Guidelines is available at
https://www.cdc.gov/vaccines/hcp/acip-recs/index.html

Current immunization schedules that summarize ACIP recommendations for currently licensed vaccines for children, adolescents and adults are available at
https://www.cdc.gov/vaccines/schedules/hcp/index.html

Recommendation

Both general and vaccine-specific Advisory Committee on Immunization Practices (ACIP) recommendations are available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html

The field of immunization is marked by constant change, including licensing of new vaccines, new vaccination recommendations, and new findings about how vaccines work and their adverse events. The most current recommendations and guidelines provides health care providers with ACIP’s best practices guidance on immunization.

Strength of Recommendation

The strength of vaccine-specific Advisory Committee on Immunization Practices (ACIP) recommendations are summarized using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods and evidence tables that accompany ACIP recommendations and are available at
https://www.cdc.gov/vaccines/acip/recs/grade/table-refs.html

References:
Ahmed et al. U.S. ACIP Handbook for Developing Evidence-based Recommendations. Version 1.2. Atlanta, GA: Centers for Disease Control and Prevention (CDC); 2013.
Guyatt GH, Oxman AD, Vist GE, et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926.

Quality of Evidence

The quality of evidence for vaccine-specific Advisory Committee on Immunization Practices (ACIP) recommendations are summarized using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods and evidence tables that accompany ACIP recommendations and are available at
https://www.cdc.gov/vaccines/acip/recs/grade/table-refs.html

References:
Ahmed et al. U.S. ACIP Handbook for Developing Evidence-based Recommendations. Version 1.2. Atlanta, GA: Centers for Disease Control and Prevention (CDC); 2013.
Guyatt GH, Oxman AD, Vist GE, et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926.

Decision Notes

Decision notes for the Advisory Committee on Immunization Practices (ACIP) recommendations that apply to all vaccine groups and that are vaccine-specific are available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html

Artifact Decision Notes

Decision notes for the Immunization Calculation Engine (ICE) that apply to all vaccine groups and that are specific to a vaccine group are available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/14352468/Default+Immunization+Schedule

Artifact Representation
Triggers
  1. Provider opens a clinical encounter
  2. Provider executes population-level assessment of immunization status
Interventions and Actions

The evaluation codes and corresponding reasons and the recommendation codes and corresponding reasons are available at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/14352480/Evaluation+and+Recommendation+Codes

Interventions and actions for each vaccine group are available in blue text boxes at https://cdsframework.atlassian.net/wiki/spaces/ICE/pages/14352468/Default+Immunization+Schedule

Testing Experience
Pilot Experience

Each release of the Immunization Calculation Engine has been tested extensively before release to the general public.

ICE is being used in production throughout the country in clinics, immunization information systems at Public Health Agencies, and by electronic health record systems and personal health record systems.