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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
OpenCDS: an Open-Source, Standards-Based, Service-Oriented
Framework for Scalable CDS
OpenCDS: an Open-Source, Standards-Based, Service-Oriented
Framework for Scalable CDS
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
DisclosureDisclosure
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
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Presentation OverviewPresentation Overview
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Presentation OverviewPresentation Overview
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
The ProblemThe 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
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
The NeedThe Need
Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health
Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Presentation OverviewPresentation Overview
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Rationale for Open, Standards-Based CDS ServicesRationale for Open, Standards-Based CDS Services
Why CDS services?Encapsulates knowledge in highly reusable componentsSupports multiple knowledge representation approachesValidated 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
Why CDS services?Encapsulates knowledge in highly reusable componentsSupports multiple knowledge representation approachesValidated 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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
CDS Services – Architectural OverviewCDS Services – Architectural Overview
Decision Support Service
Decision Support Service
Knowledge Modules
Knowledge Modules
Institution A Institution A
Client Decision Support Apps
Client Decision Support Apps
Patient Data Sources
Patient Data Sources
Queries for required ptdata
Queries for required ptdata
Institution B Institution B
Client Decision Support Apps
Client Decision Support Apps
Patient Data Sources
Patient Data Sources
Queries for required ptdata
Queries for required ptdata
Conclusions about patientConclusions about patient
Patient data, knowledge modules to use
Patient data, knowledge modules to use
Trigger
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) ]
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) ]
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
CDS Services – ExampleCDS Services – Example
Decision Support Service
Decision Support Service
EHR SystemEHR System Patient Data Sources
Patient Data Sources
Pt dataPt
dataCCDCCD
VMRVMREval.
ResultEval.
Result
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Presentation OverviewPresentation Overview
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
OpenCDS – Sample TopologiesOpenCDS – Sample Topologies
DSS ClientDSS Client
OpenCDS DSS InterfaceOpenCDS DSS Interface
OpenCDSAdapter XOpenCDSAdapter X
OpenCDSDrools Adapter
OpenCDSDrools Adapter
OpenCDS Drools Engine
OpenCDS Drools Engine
CDS Engine/Service X (e.g., SEBASTIAN,KMR-DDSS, CDSC)
CDS Engine/Service X (e.g., SEBASTIAN,KMR-DDSS, CDSC)
OpenCDS Drools Knowledge
Authoring Platform
OpenCDS Drools Knowledge
Authoring Platform
OpenCDS XML Knowledge
Authoring Platform
OpenCDS XML Knowledge
Authoring Platform
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
OpenCDS – Terminology Mgmt. with ApelonOpenCDS – Terminology Mgmt. with Apelon
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
OpenCDS – Terminology Mgmt. with ApelonOpenCDS – Terminology Mgmt. with Apelon
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
OpenCDS – DemoOpenCDS – Demo
DSS ClientDSS Client
OpenCDS DSS InterfaceOpenCDS DSS Interface
OpenCDSDrools Adapter
OpenCDSDrools Adapter
OpenCDS Drools Engine
OpenCDS Drools Engine
OpenCDS Drools Knowledge
Authoring Platform
OpenCDS Drools Knowledge
Authoring Platform
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Presentation OverviewPresentation Overview
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
ProblemNeed for scalable clinical decision support (CDS)
Potential SolutionStandards-based, open-source CDS services
OpenCDS
Discussion
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
Key Benefits of ApproachKey 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
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
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
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
Limited content availability
Provide federal funding for content development Create an interoperable, standards-based market for such knowledge
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
AcknowledgementsAcknowledgements Research support
NHGRI K01 HG004645 (PI: K. Kawamoto)
OpenCDS collaboratorsJack Bowie
Guilherme Del Fiol
Sandi Geary
Peter Haug
Kevin Hughes
Keith Larsen
Stratton Lloyd
Research supportNHGRI K01 HG004645 (PI: K. Kawamoto)
OpenCDS collaboratorsJack 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
Kevin Meldrum
Javed Mostafa
Jonathan Nebeker
Oakkar Oakkar
Kraig Robson
David Shields
Jason Skowronski
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©2010, Kensaku Kawamoto©2010, Kensaku Kawamoto
www.opencds.orgwww.opencds.org