Computer-Supported Collaborative Design of Standardized Clinical Cases: Algorithm Development and Validation

The creation of computer-supported collaborative clinical cases is an area of educational research that has been widely studied. However, the reuse of cases and their sharing with other platforms is a problem, as it encapsulates knowledge in isolated platforms without interoperability. This paper proposed a workflow ecosystem for the collaborative design and distribution of clinical cases through web-based computing platforms that (1) allow medical students to create clinical cases collaboratively in a dedicated environment; (2) make it possible to export these clinical cases in terms of the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) interoperability standard; (3) provide support to transform imported cases into learning object repositories; and (4) use e-learning standards (eg, Instructional Management Systems Content Packaging [IMS-CP] or Sharable Content Object Reference Model [SCORM]) to incorporate this content into widely-used learning management systems (LMSs), letting medical students democratize a valuable knowledge that would otherwise be confined within proprietary platforms.

This study aimed to demonstrate the feasibility of developing a workflow ecosystem based on IT platforms to enable the collaborative creation, export, and deployment of clinical cases.

The ecosystem infrastructure for computer-supported collaborative design of standardized clinical cases consists of three platforms: (1) Mosaico, a platform used in the design of clinical cases; (2) Clavy, a tool for the flexible management of learning object repositories, which is used to orchestrate the transformation and processing of these clinical cases; and (3) Moodle, an LMS that is geared toward publishing the processed clinical cases and delivering their course deployment stages in IMS-CP or SCORM format. The generation of cases in Mosaico is exported in the HL7 FHIR interoperability standard to Clavy, which is then responsible for creating and deploying a learning object in Moodle.

The main result was an interoperable ecosystem that demonstrates the feasibility of automating the stages of collaborative clinical case creation, export through HL7 FHIR standards, and deployment in an LMS. This ecosystem enables the generation of IMS-CPs associated with the original Mosaico clinical cases that can be deployed in conventional third-party LMSs, thus allowing the democratization and sharing of clinical cases to different platforms in standard and interoperable formats.

In this paper, we proposed, implemented, and demonstrated the feasibility of developing a standards-based workflow that interoperates multiple platforms with heterogeneous technologies to create, transform, and deploy clinical cases on the web. This achieves the objective of transforming the created cases into a platform for web-based deployment in an LMS.