OpenCDS: an Open-Source, Standards-Based, Service-Oriented Framework for Scalable CDS

1. OpenCDS: an Open-Source, Standards-Based, Service-Oriented Framework for Scalable CDS AMIA 2010 Fall Symposium November 17, 2010 Kensaku Kawamoto, MD, PhD (kawam001@mc.duke.edu) Assistant Professor Duke Center for Health Informatics

2. Disclosure • Dr. Kawamoto is a co-founder of Clinica Software, Inc., which provides open-source health IT solutions that utilize the Decision Support Service technology described in this presentation • Clinica will make any of its IP necessary for implementing the Decision Support Service standards discussed in this presentation available for free

3. Presentation Overview Problem Need for scalable clinical decision support (CDS) Potential Solution Standards-based, open-source CDS services OpenCDS Discussion

4. Presentation Overview Problem Need for scalable clinical decision support (CDS) Potential Solution Standards-based, open-source CDS services OpenCDS Discussion

5. The Problem Despite demonstrated effectiveness, CDS is not widely available The lack of CDS availability is due in part to the tight coupling of CDS capabilities with specific institutions and health IT systems

6. The Need Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health

7. Presentation Overview Problem Need for scalable clinical decision support (CDS) Potential Solution Standards-based, open-source CDS services OpenCDS Discussion

8. Rationale for Open, Standards-Based CDS Services Why CDS services? Encapsulates knowledge in highly reusable components Supports multiple knowledge representation approaches Validated by several groups, including users of SEBASTIAN CDS service (see panel in next session) Why standards-based? To enable interoperability and scalability Why open source? To foster adoption and collaboration

9. CDS Services – Architectural Overview Patient data, knowledge modules to use Patient Data Sources Patient Data Sources Conclusions about patient Institution B Queries for required pt data Queries for required pt data Client Decision Support Apps Client Decision Support Apps Knowledge Modules Standard Interface: HL7/OMG Decision Support Service Standard (http://hssp-dss.wikispaces.com) Standard Service Payloads: HL7 Virtual Medical Record (vMR) Standard [ http://wiki.hl7. org/index.php?title= Virtual_Medical_Record_(vMR) ] Institution A Trigger Decision Support Service

10. CDS Services – Example Patient Data Sources Eval. Result VMR CCD Pt data Decision Support Service EHR System

11. Presentation Overview Problem Need for scalable clinical decision support (CDS) Potential Solution Standards-based, open-source CDS services OpenCDS Discussion

12. OpenCDS • Goal • Facilitate widespread availability of advanced CDS capabilities through open-source, collaborativedevelopment of standards-based DSS infrastructure, tooling, and high-value services • Methods • Contribute through Open Health Tools • Leverage open-source JBoss Drools rules engine • Use modular architecture, enable iterative refinement, support multiple knowledge represent. approaches • Develop all components required to author, test, and operationally support standards-compliant DSSs

13. Key Components • Standard interfaces and data models • Reference implementation of HL7/OMG DSS interface • vMR data model • Data mappers (e.g., for CCD  vMR) • Reference DSS knowledge management framework • JBoss Drools and associated authoring/knowledge management tools • Full-featured terminology support • A “domain specific language” for intuitive knowledge authoring • DSS “wrappers” for other CDS engines

14. OpenCDS – Sample Topologies DSSClient OpenCDS DSS Interface OpenCDS Drools Adapter OpenCDS Adapter X OpenCDS Drools Engine CDS Engine/Service X (e.g., SEBASTIAN, KMR-DDSS, CDSC) OpenCDS XML Knowledge Authoring Platform OpenCDS Drools Knowledge Authoring Platform

15. Current OpenCDS Collaborators • Duke Center for Health Informatics • Ken Kawamoto (PI), David Shields, Guilherme Del Fiol • Veterans Health Administration • Intermountain Healthcare • University of North Carolina at Chapel Hill • Massachusetts General Hospital • EBSCO • Apelon, Inc. • Clinica Software, Inc. • IsoDynamic, Inc. • Keona Health • Visumpoint, LLC

16. OpenCDS – Terminology Mgmt. with Apelon

17. OpenCDS – Terminology Mgmt. with Apelon

18. OpenCDS – Demo DSSClient OpenCDS DSS Interface OpenCDS Drools Adapter OpenCDS Drools Engine OpenCDS Drools Knowledge Authoring Platform

19. Presentation Overview Problem Need for scalable clinical decision support (CDS) Potential Solution Standards-based, open-source CDS services OpenCDS Discussion

20. Key Benefits of Approach Builds on robust open-source community and resources Provides standard architectural framework for integrating various CDS knowledge resources Supports full life cycle of knowledge authoring, testing, maintenance, and execution Provides an open-source framework for collaboration and innovation in CDS

21. Key Challenges and Potential Solutions • Bottom line assessment: benefits >> challenges

22. Acknowledgements • Research support • NHGRI K01 HG004645 (PI: K. Kawamoto) • OpenCDS collaborators • Jack Bowie • Guilherme Del Fiol • Sandi Geary • Peter Haug • Kevin Hughes • Keith Larsen • Stratton Lloyd • Kevin Meldrum • Javed Mostafa • Jonathan Nebeker • Oakkar Oakkar • Kraig Robson • David Shields • Jason Skowronski

23. www.opencds.org