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Requirements For Real-Time Clinical Decision Support Drools Workshop 2010 San Diego, CA

Requirements For Real-Time Clinical Decision Support Drools Workshop 2010 San Diego, CA. Background. Clinical Decision Support a key to realizing “Meaningful Use”, personalized healthcare, patient safety and self-empowerment

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Requirements For Real-Time Clinical Decision Support Drools Workshop 2010 San Diego, CA

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  1. Requirements For Real-Time Clinical Decision SupportDrools Workshop 2010San Diego, CA Emory Fry, MD 23 March 2010

  2. Background Clinical Decision Support a key to realizing “Meaningful Use”, personalized healthcare, patient safety and self-empowerment DDSS/KMR is a DoD effort to create a reference implementation of a real-time CDS service Leverages our work creating a standards-based, semantically constrained SOA for the Nationwide Health Information Network www.SocraticGrid.org

  3. Changing Behavior: Healthcare's “Last Mile” • Achieving & Sustaining Health • Knowing what to do • Knowing how to do it • Knowing when to do it • Behavioral Entropy • Workflow reengineering • Making it easier to do the right thing than not • Achieving the highest degree of healthy behavior with a state of stable energy expenditure www.SocraticGrid.org

  4. Behavioral Entropy www.SocraticGrid.org

  5. Functional Scenarios • Scenarios and Use Cases at www.SocraticGrid.org www.SocraticGrid.org

  6. www.SocraticGrid.org

  7. Mobility Applications www.SocraticGrid.org

  8. Personalized Care Plan Patient: Doe, John A. Weight Reduction Plan Nonlinear – Dr. Thomas Actuals 250 Planned 247 240 Weight in lbs. 229 230 222 220 217 213 211 210 210 200 11/30/2007 1/31/2008 3/30/2008 5/31/2008 9/30/2007 5/31/2007 7/30/2007 Begin End Plan Evaluation Dates/Milestones vs. Actuals www.SocraticGrid.org

  9. www.SocraticGrid.org

  10. www.SocraticGrid.org

  11. Encode the Logic of Care • Context: When is a specific decision / rule appropriate? • Data: What information is required to make this decision? • Decision Rule: What logical expressions encode this decision? www.SocraticGrid.org

  12. Encode the Workflow of Care • How is the decision process triggered? • How are decisions communicated to the right user at the right time and place? • Does the system help accomplished the suggested tasks? • How are alerts/suggestions acknowledged by the user? www.SocraticGrid.org

  13. CDS System Knowledge Repository Modeling Environments for Developing Logic Exchange Language For Logic / Workflow System Strategy for Implementation Flowcharts/Editors?

  14. Decision Support Service & Knowledge Management Repository Email Pager ??? NotificationRules InstitutionalRules PrivateRules Metadata Task Service Decision Support Service DECISION REQ MSG KMR Service Decision Request Queue Fact Handler Fact Queue Event Service HL7 CAL HIS HL7 Source HL7 Integration Engine

  15. Architectural Design

  16. DDSS-KMR Approach Develop data models using NHIN standards, HL7 CDS Working Group, IHE, and NIEM Identify standardized terminologies when ever possible for value sets (i.e., LOINC, SNOMED, etc) Create “placeholder” value sets for concepts without exiting terminologies to support the use cases Working with OASIS / HL7 on security framework for access control to clinical objects or “facts” Working with HL7, Morningside, Partners, and others on developing functional semantics for workflow actions www.SocraticGrid.org

  17. Decision Support Service: Rules Individualized To Patient Email Pager System Message Order NotificationRules InstitutionalRules PrivateRules Metadata Task Service Working Memory Patient #1 Working Memory Patient #2 Working Memory Patient #3 Decision Support Service Decision Support Service Decision Support Service KMR Service Event Service CAL HIS HL7 Source HL7 Integration Engine

  18. Working Memory & The Virtual Medical Record Virtual Medical Record Drools Rule Engine Dx Fact Rx Fact Demographic Fact Lab Fact Dx Fact Rx Fact Demographic Fact Lab Fact Dx Fact Rx Fact Demographic Fact Lab Fact Dx Fact Rx Fact Demographic Fact Lab Fact Decision Support Service Patient #1 New Fact Event Service CAL HIS HL7 Source HL7 Integration Engine

  19. New Requirements For Drools Loading and unloading of rules / knowledge bases Rule engine state management Scalability Inference Engine performance Rich, fully functional Web Service API Remote invocation Workflow functionality and human task www.SocraticGrid.org

  20. Questions? www.SocraticGrid.org

  21. Limitations Current Medical Vocabularies / Ontologies Inadequate No organizational ontology No functional ontology No operational environment terminologies Data Structures Inadequately Constrained Security Framework Medical-Legal Framework www.SocraticGrid.org

  22. AIM #1 Fully document KMR and Clinical Decision Support Engine functional requirements, technical design, and interface controls using MHS standard documentation methodologies www.SocraticGrid.org

  23. AIM #2 Develop the technical infrastructure and tools to support domain knowledge development, management, dissemination, and run-time execution of computable clinical decision support algorithms and automated clinical practice guidelines as a service for the NHIN bus www.SocraticGrid.org

  24. AIM #3 Demonstrate execution of these computable clinical guidelines using the MHS AHLTA client and data repository www.SocraticGrid.org

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