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Open Source Clinical Decision Support

Open Source Clinical Decision Support. Emory Fry, MD Cognitive Medical Systems January 14, 2014. Cognitive Medical Systems. Transform healthcare through innovative software solutions, platforms and tools

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Open Source Clinical Decision Support

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  1. Open Source Clinical Decision Support Emory Fry, MD Cognitive Medical Systems January 14, 2014

  2. Cognitive Medical Systems • Transform healthcare through innovative software solutions, platforms and tools • Specialize in healthcare standards, clinical workflow, decision support, and system integration • Founded in 2011, headquartered in San Diego, CA • Professional services currently focused on DoD, VA, and intuitional healthcare organizations • Developing Open Source (Apache 2.0) and commercial products

  3. Development Strategy • Reuse and contribute to OSS where ever possible • Sponsor the open source Socratic Grid community • Continue research and innovation in clinical decision support, workflow optimization, and data visualization • Provide standards-compliant terminology and data transformation services • Develop collaborative relationships and integrate domain expertise • Establish and maintain a reference Clinical Decision Support laboratory for the community, its partners, and academia

  4. Socratic Grid Architecture

  5. Cross Domain Data Aggregation & CDS ACME Client Inbox Inbox Inbox iPhone Client Portal Inbox CDS Service CDS Service Task Manager Event Service Connect Adaptor GUI Services Connect Adaptor Fact Service CAL Aggregation Site A Site B Site C Site D

  6. Functional Components • Standards-based Data Transformation Services • CTS v2.0 Terminology Service • MDWS to HL7 FHIR & vMR structural transformation • Triple Store: RXNORM, SNOMED, LOINC, NDFRT and ICD9 SKOS graphs • Workflow management and flexible inference • BPEL processes, production rules, PPML interface • CCOW enabled portal framework • CDS alert “inbox”

  7. Data Transformation Services FHIR Objects Socratic Grid ESB Transformation Services Terminology Service Data Transformation Graph Data Management Framework EMR

  8. MDWS To FHIR Mappings

  9. Terminology Services • SKOS ontologies for RXNORM, SNOMED, LOINC, and NDFRT; stored in Jena triple store; searchable using SPARQL; exposed using HL7 CTS2 SOA Service; deployed on iEHR ESB

  10. CDS “Facts” Rule Engine Portal Inbox vMR Observation Result HL7 vMR Objects FHIR Objects

  11. Individualized Stateful Rule Sessions Individual Stateful Rule Sessions

  12. CCOW-Enabled Portal Framework

  13. Predictive Analytics

  14. Universal Inbox

  15. Janus Legacy Viewer Inbox Plugin

  16. CDS Prototype: Drug-Genome Check Pharmacogenomics Graph Patient GenomeGraph CDS HL7 Socratic Grid ESB Transformation Services Terminology Service (Jena) Data Transformation (Graph) RDF Graph Data Management Framework VistA

  17. Pharmacogenomic CDS

  18. Other Exemplar CDS Use Cases • Drug-disease interaction checks • Drug-laboratory trending checks • VA Clinical Reminders • BMI calculation • Hypertension Reminder • HbA1C Reminder • Colorectal Cancer Screening Reminder • Lipid Panel Reminder • IHTSDO EL++ Demonstration

  19. Conclusion • Socratic Grid is a reference implementation for CDS and human process reengineering research • Goal is to create an open source“stack”, using VistA as the reference EMR, suitable for government, academic, and industry innovation • Please join the community and help us iteratively improve the architecture, leverage multi-disciplinary perspectives and improve the basic infrastructure available to healthcare

  20. Socratic Grid • License: Apache 2.0 • Repository: https://github.com/SocraticGrid • Socratic Grid has joined Open Health Tools • Stewardship • Cognitive Medical Systems, San Diego, CA • www.cognitivemedicine.com

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