©2010, kensaku kawamoto sebastian, related initiatives, and lessons learned amia 2010 fall...

©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto

SEBASTIAN, Related Initiatives, and Lessons Learned

SEBASTIAN, Related Initiatives, and Lessons Learned

AMIA 2010 Fall SymposiumNovember 17, 2010

Kensaku Kawamoto, MD, PhD ([email protected])

Assistant ProfessorDuke Center for Health Informatics

AMIA 2010 Fall SymposiumNovember 17, 2010

Kensaku Kawamoto, MD, PhD ([email protected])

Assistant ProfessorDuke Center for Health Informatics


Presentation OverviewPresentation Overview

SEBASTIAN

Duke Chronic Disease Management System

Key Standards for Scalable CDS Services

OpenCDS

Discussion

SEBASTIAN



OpenCDS

Discussion


SEBASTIAN CDS Web Service – OverviewSEBASTIAN CDS Web Service – Overview

System for Evidence-Based Advice through Simultaneous Transaction with an Intelligent Agent across a Network

Designed and developed by presenter to efficiently meet needs of multiple CDS efforts

Core SEBASTIAN features:Uses a patient information model based on HL7

Reference Information Model Terminology support provided using NLM’s UMLSEncapsulates medical knowledge in XML documents

known as Executable Knowledge Modules (EKMs)Uses the EKMs to act as a CDS service

Ref: Kawamoto K et al. Proc / AMIA Annual Symp, 2005.

System for Evidence-Based Advice through Simultaneous Transaction with an Intelligent Agent across a Network

Designed and developed by presenter to efficiently meet needs of multiple CDS efforts

Core SEBASTIAN features:Uses a patient information model based on HL7

Reference Information Model Terminology support provided using NLM’s UMLSEncapsulates medical knowledge in XML documents

known as Executable Knowledge Modules (EKMs)Uses the EKMs to act as a CDS service

Ref: Kawamoto K et al. Proc / AMIA Annual Symp, 2005.


SEBASTIAN – Architectural OverviewSEBASTIAN – Architectural Overview

SEBASTIAN CDS ServiceSEBASTIAN CDS Service

Knowledge Modules

Knowledge Modules

Institution A Institution A

Client Decision Support Apps


Patient Data Sources


Queries for required ptdata


Institution B Institution B







Conclusions about patientConclusions about patient

Patient data, knowledge modules to use

Patient data, knowledge modules to use

Trigger


EKM Authoring – Metadata EntryEKM Authoring – Metadata Entry


EKM Authoring – Input Data SpecificationEKM Authoring – Input Data Specification


EKM Authoring – Output SpecificationEKM Authoring – Output Specification


EKM Authoring – Logic Section (InfoPath)EKM Authoring – Logic Section (InfoPath)


EKM Authoring – Logic Section (Java IDE)EKM Authoring – Logic Section (Java IDE)


EKM Testing – Single Test Case EvaluationEKM Testing – Single Test Case Evaluation


EKM Testing – Batch EvaluationEKM Testing – Batch Evaluation


SEBASTIAN StatusSEBASTIAN Status

In operational use across multiple institutionsDuke point-of-care disease management systemDuke enterprise care quality reporting systemNC Medicaid care manager alerting systemNC Medicaid patient reminder letter systemNC Medicaid medication management systemNC Medicaid provider portalHospital Italiano breast cancer management systemDana-Farber Cancer Institute cancer symptom

management system

In operational use across multiple institutionsDuke point-of-care disease management systemDuke enterprise care quality reporting systemNC Medicaid care manager alerting systemNC Medicaid patient reminder letter systemNC Medicaid medication management systemNC Medicaid provider portalHospital Italiano breast cancer management systemDana-Farber Cancer Institute cancer symptom

management system


Duke Dz. Mgmt. System – ArchitectureDuke Dz. Mgmt. System – Architecture

SEBASTIAN CDS ServiceSEBASTIAN CDS Service

Knowledge Modules

Knowledge Modules

Institution A Institution A

Duke Clinical Information

Viewer

Duke Clinical Information

Viewer





Dz. mgmt. conclusions about patientDz. mgmt. conclusions about patient

Patient data, dz.mgmt. modules to use

Patient data, dz.mgmt. modules to use

Dz. mgmt. invocation


Example Disease Management RemindersExample Disease Management Reminders

Source: Duke University Health System. Lobach DF, Kawamoto K, et al. Medinfo. 2007;861-5.Source: Duke University Health System. Lobach DF, Kawamoto K, et al. Medinfo. 2007;861-5.


UsageUsage


Example Care Quality ReportingExample Care Quality Reporting

Source: Duke University Health System.Source: Duke University Health System.



SEBASTIAN



OpenCDS

Discussion

SEBASTIAN



OpenCDS

Discussion


HL7/OMG Decision Support Service standardHL7/OMG Decision Support Service standard Specifies standard service interface for CDS

services

Part of larger HL7-OMG Healthcare Services Specification Project (Kawamoto, JAMIA, 2009)

Effort led by presenter since 2005; based largely on SEBASTIAN service interface

Adopted as HL7 draft standard in 2006

Adopted as OMG draft standard in 2009; normative status expected December 2010

Available from http://hssp-dss.wikispaces.com

Specifies standard service interface for CDS services

Part of larger HL7-OMG Healthcare Services Specification Project (Kawamoto, JAMIA, 2009)

Effort led by presenter since 2005; based largely on SEBASTIAN service interface

Adopted as HL7 draft standard in 2006

Adopted as OMG draft standard in 2009; normative status expected December 2010

Available from http://hssp-dss.wikispaces.com


HL7 Virtual Medical Record StandardHL7 Virtual Medical Record Standard

Problem addressedFor scalable CDS and knowledge sharing, need

standard information models for CDS inputs (e.g., patient data) and CDS outputs (e.g., recommended orders)

Provides:Standard “payloads” for CDS services Standard computational model for knowledge authoring

Status Initial ballot May 2010; active ongoing work

Wikihttp://wiki.hl7. org/index.php?title=Virtual_Medical_

Record_(vMR)

Problem addressedFor scalable CDS and knowledge sharing, need

standard information models for CDS inputs (e.g., patient data) and CDS outputs (e.g., recommended orders)

Provides:Standard “payloads” for CDS services Standard computational model for knowledge authoring

Status Initial ballot May 2010; active ongoing work

Wikihttp://wiki.hl7. org/index.php?title=Virtual_Medical_

Record_(vMR)



SEBASTIAN



OpenCDS

Discussion

SEBASTIAN



OpenCDS

Discussion


OpenCDSOpenCDS

Goal Facilitate widespread availability of advanced CDS

capabilities through open-source, collaborative development of standards-based DSS infrastructure, tooling, and high-value services

MethodsContribute through Open Health ToolsLeverage open-source JBoss Drools rules engineUse modular architecture, enable iterative refinement,

support multiple knowledge represent. approaches Develop all components required to author, test, and

operationally support standards-compliant DSSs

Goal Facilitate widespread availability of advanced CDS

capabilities through open-source, collaborative development of standards-based DSS infrastructure, tooling, and high-value services

MethodsContribute through Open Health ToolsLeverage open-source JBoss Drools rules engineUse modular architecture, enable iterative refinement,

support multiple knowledge represent. approaches Develop all components required to author, test, and

operationally support standards-compliant DSSs


Key ComponentsKey Components

Standard interfaces and data modelsReference implementation of HL7/OMG DSS interfacevMR data modelData mappers (e.g., for CCD vMR)

Reference DSS knowledge management frameworkJBoss Drools and associated authoring/knowledge

management toolsFull-featured terminology supportA “domain specific language” for intuitive knowledge

authoring

DSS “wrappers” for other CDS engines

Standard interfaces and data modelsReference implementation of HL7/OMG DSS interfacevMR data modelData mappers (e.g., for CCD vMR)

Reference DSS knowledge management frameworkJBoss Drools and associated authoring/knowledge

management toolsFull-featured terminology supportA “domain specific language” for intuitive knowledge

authoring

DSS “wrappers” for other CDS engines


OpenCDS – Sample TopologiesOpenCDS – Sample Topologies

DSS ClientDSS Client

OpenCDS DSS InterfaceOpenCDS DSS Interface

OpenCDSAdapter X

OpenCDSAdapter X

OpenCDSDrools Adapter

OpenCDSDrools Adapter

OpenCDS Drools Engine

OpenCDS Drools Engine

CDS Engine/Service X (e.g., SEBASTIAN)

CDS Engine/Service X (e.g., SEBASTIAN)

OpenCDS Drools Knowledge

Authoring Platform

OpenCDS Drools Knowledge

Authoring Platform


Current OpenCDS CollaboratorsCurrent 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

Duke Center for Health InformaticsKen 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


OpenCDS – Terminology Mgmt. with ApelonOpenCDS – Terminology Mgmt. with Apelon


OpenCDS – DemoOpenCDS – Demo



SEBASTIAN



OpenCDS

Discussion

SEBASTIAN



OpenCDS

Discussion


Key Benefits and ChallengesKey Benefits and Challenges Detailed analysis available from:

Kawamoto et al. System-agnostic CDS services: benefits and challenges. Open Medical Informatics Journal, 2010 [in press].

Key benefits:Facilitates centralized knowledge management and

knowledge sharingEnables agile CDS system development through loose

coupling with other software components and servicesFacilitates implementation of CDS across applications

and care settings

Detailed analysis available from:Kawamoto et al. System-agnostic CDS services:

benefits and challenges. Open Medical Informatics Journal, 2010 [in press].

Key benefits:Facilitates centralized knowledge management and

knowledge sharingEnables agile CDS system development through loose

coupling with other software components and servicesFacilitates implementation of CDS across applications

and care settings


Key Challenges and Potential SolutionsKey Challenges and Potential Solutions

Challenge Potential solutions

Increased effort required to develop and support knowledge resources for use in multiple contexts

Balance generalizability with resource realities Spread knowledge development cost over multiple deployment settings

Bottom line assessment: benefits >> challenges Bottom line assessment: benefits >> challenges

Need for service interface to be standardized

Facilitate widespread use of HL7/OMG DSS standard and emerging HL7 vMR standard (e.g., via OpenCDS)


AcknowledgementsAcknowledgements Research support

SEBASTIAN: NLM F37-LM008161 (PI: K. Kawamoto)

OpenCDS: NHGRI K01 HG004645 (PI: K. Kawamoto)

OpenCDS collaboratorsGuilherme Del Fiol

Sandi Geary

Peter Haug

Kevin Hughes

Keith Larsen

Kevin Meldrum

Research supportSEBASTIAN: NLM F37-LM008161 (PI: K. Kawamoto)

OpenCDS: NHGRI K01 HG004645 (PI: K. Kawamoto)

OpenCDS collaboratorsGuilherme Del Fiol

Sandi Geary

Peter Haug

Kevin Hughes

Keith Larsen

Kevin Meldrum

Javed Mostafa

Jonathan Nebeker

Oakkar Oakkar

Kraig Robson

David Shields

Jason Skowronski

Javed Mostafa

Jonathan Nebeker

Oakkar Oakkar

Kraig Robson

David Shields

Jason Skowronski


www.opencds.orgwww.opencds.org

©2010, kensaku kawamoto sebastian, related initiatives, and lessons learned amia 2010 fall...

Documents

kensaku kawamoto duke

patient patient data

trigger slide

patient information

pt data queries

health informatics slide

cds service ref

medical knowledge