YOU ARE DOWNLOADING DOCUMENT

Please tick the box to continue:

Transcript
Page 1: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support Activities

Rev 1 Draft Feb 23

Page 2: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 3: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesArden Syntax Version 2.5

• Allow knowledge sharing within and between institutions

• Make medical knowledge and logic explicit

• Standardize the way medical knowledge is integrated into hospital information systems

Page 4: HL7 Decision Support Activities Rev 1 Draft Feb 23.

•Has been used to encode guidelines (as hierarchy of MLMs)

•Consensus: Not ideally suited for guidelines

•Entry points and eligibility criteria (not triggers)•Flow of steps (not procedures)

•Ongoing work•Arden as a separate standard for simple alerts•Examine other models for guidelines

HL7 Decision Support ActivitiesArden Syntax Version 2.5

Page 5: HL7 Decision Support Activities Rev 1 Draft Feb 23.

Finalized “dot notation” and object references

Added operators: Object declaration, object creation, object references, reading into an object

Deferred decisions

Primary time of objects

Passing objects by reference or by value

Change the granularity of the PRIORITY slot

Allow the WHILE statement with assignment in the ACTION slot

HL7 Decision Support ActivitiesArden Syntax Version 2.5

Page 6: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 7: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesGELLO

A Guideline Expression Language

•Purposes•Query data (READ)•Logically manipulate data (IF-THEN, etc)

•Current work: GELLO (BWH) = Guideline Expression Language

Page 8: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesGELLO

•Original goal (InterMed): Procedural component for high-level guideline format (GLIF)

•Subsequent goal: Provide similar functionality for current HL7 KR standard (Arden Syntax)

•Emphasis: Shareability of queries and expressions

•Mechanism: Reference data in OO fashion

Page 9: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesGELLO

•Provides basic data types

•Allows reference to underlying standard data model (vMR)

•Based on the Object Constraint Language (UML)

•Current goal: Ballot as a separate HL7 standard during the coming 12 months

Page 10: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 11: HL7 Decision Support Activities Rev 1 Draft Feb 23.

•Problem with RIM: Too abstract

•Potential solution: Tailored version of RIM specifically for decision support

•Current work: Virtual Medical Record •Establish distinct objects that in RIM might be high-level classes (with mood and other attributes)

•Key classes: patient, plan, procedure, medication, appointment, referral, goal and assessment

HL7 Decision Support ActivitiesvMR

Page 12: HL7 Decision Support Activities Rev 1 Draft Feb 23.

13 classes

Most classes directly from the RIM

Most attributes have direct RIM mappings

Classes & attributes refined iteratively with each new guideline

SAGE vMR

HL7 Decision Support ActivitiesvMR

Page 13: HL7 Decision Support Activities Rev 1 Draft Feb 23.

13 classes

Most classes directly from the RIM

Most attributes have direct RIM mappings

Classes & attributes refined iteratively with each new guideline

SAGE vMR

HL7 Decision Support ActivitiesvMR

Page 14: HL7 Decision Support Activities Rev 1 Draft Feb 23.

SAGE vMR

HL7 Decision Support ActivitiesvMR

Page 15: HL7 Decision Support Activities Rev 1 Draft Feb 23.

SAGE vMR Classes

• Observation• Procedure• Problem• Order• Medication Order• Substance

Administration

• Encounter• Referral• Appointment• Goal• Adverse Reaction• Alert• Agent

HL7 Decision Support ActivitiesvMR

Page 16: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesvMR - Challenges

•Need standard vocabularies

•Agreement is difficult•Solution: Format for referring to a standard vocabulary in data references•Examples: SNOMED-CT, ICD-9, LOINC, CPT, etc•Implementation: One-time mapping between local and standard vocabularies

•Facilitation: Free licensing of SNOMED in USA as part of UMLS

Page 17: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 18: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Rationale for Guidelines: Knowledge dissemination

• HL7: Role of the SDO in knowledge representation

• Shareable components of computable guidelines

• Guideline models

• Convergence & the future

HL7 Decision Support ActivitiesGuidelines

Page 19: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Use in context of systems for providing patient care– CPOE– EMR

• Use at the time decisions are being made• Ample success for limited alerts/reminders

– Medication prescribing practices– Preventive care: screening tests,

immunizations

• Less demonstrated success for complex guidelines

HL7 Decision Support ActivitiesGuidelines - Objectives

Page 20: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Avoid duplication of effort when using common guidelines in many institutions

• Rapid dissemination of modifications

• Encourage development of tools for retrieving and using guideline information

• Encourage future guideline authors to be more rigorous (decreased ambiguity)

HL7 Decision Support ActivitiesGuidelines - Benefits

Page 21: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Many models: GEODE-CM, GLIF, Arden Syntax, EON, DILEMMA, PROforma, Asbru, GEM, GUIDE, PRODIGY, …

• Many stakeholders: government, vendors, academics, professional organizations, etc

• Many types of guidelines

• Many types of (paper) guideline formats: narrative text, tables, flowcharts, graphs, maps, lists, critical pathways, if-then statements, etc.

HL7 Decision Support ActivitiesGuidelines - Challenges

Page 22: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Availability of data

• Identification of data: structured, controlled vocabularies

• Clinical data repositories: Data model

• Shareable knowledge representationShareable knowledge representation

HL7 Decision Support ActivitiesGuidelines - Challenges

Page 23: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Opposing view: A single formalism may not be possible or desirable– Complexity of guidelines and their purposes– Result: A small number of “niche” formalisms

• Arden for simple alerts/reminders• Others for complex guidelines

– A small group of formalisms would share common components (data model, vocabulary, expression language)

HL7 Decision Support ActivitiesGuidelines – An approach?

Page 24: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 25: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Infobutton is a point-of-care application that retrieves context-specific information from content providers using patient data extracted from the electronic medical record– Can be implemented as an HTTP request– Query parameters embedded in the URL

HL7 Decision Support ActivitiesInfobutton Definition

Page 26: HL7 Decision Support Activities Rev 1 Draft Feb 23.
Page 27: HL7 Decision Support Activities Rev 1 Draft Feb 23.

i

What are the clinical manifestations of high serum potassium?

•65 years old•female•physician•lab results

Question formulation

Resource 3

Resource 1

Resource 2?

Resource selection

Answer

Answer retrieval

Page 28: HL7 Decision Support Activities Rev 1 Draft Feb 23.

Non-standard APIs

POE system

Lab results review

Outpatient clinical information system

i

i

i

InfobuttonManager 1

InfobuttonManager 2

Resource 1

Resource 2

Resource 3

API

API

API

API

API

Page 29: HL7 Decision Support Activities Rev 1 Draft Feb 23.

Standard APIs

InfobuttonManager 1

InfobuttonManager 2

POE system

Lab results review

Outpatient clinical information system

i

i

i

Resource 1

Resource 2

Resource 3

HL7 HL7

HL7

Page 30: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Username & password• Context

– Patient: age and gender– User: patient, physician, nurse– App context: Problems, Medications, Labs, etc.

• Concept: Concept ^ String ^ Terminology• Query modifier

HL7 Decision Support ActivitiesInfobutton Proposed Parameters

Page 31: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• http://www.knowledgesourcewebsite.com/search.cgi?applicationContext=problems&conceptOfInterest=D018410&SearchString=Bacterial Pneumonia&terminology=MeSH&contentTarget=physician– Runs a search for D018410 (MeSH), on the

problems section of the knowledge source, and with focus on content for physicians

HL7 Decision Support ActivitiesInfobutton Proposed Example

Page 32: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 33: HL7 Decision Support Activities Rev 1 Draft Feb 23.

“Order sets allow a care provider to choose common orders for a particular disease state or circumstance according to best practice or other criteria for assembling the order set without having to generate each order individually. The EHR may recommend order sets in certain conditions or as the result of other clinical information being entered into the EHR. Or the order sets may simply be available for use by the ordering care provider “

HL7 Decision Support ActivitiesOrder Set Functional Description (EHR DSTU Draft)

Page 34: HL7 Decision Support Activities Rev 1 Draft Feb 23.

Support a sequencing of orders for logical and useful presentation to the ordering provider

Support explanatory (non-actionable) sequenced elements for ease of use and informational content

Order sets may be nested within order sets in order to support editorial efficiency and to avoid clinical and administrative update anomalies

Order sets have a unique identification key which supports identification and use in multiple order sets

Support identification of an author and brief editorial history in the header

Support menu features which include “AND”, “XOR” at the level of order selection

HL7 Decision Support ActivitiesOrder Set Requirements

Page 35: HL7 Decision Support Activities Rev 1 Draft Feb 23.

• Each order has a clear text description• Support mapping to enterprise order master. • Provide a readable version of the orders and the

order set.

HL7 Decision Support ActivitiesOrder Set Requirements

Page 36: HL7 Decision Support Activities Rev 1 Draft Feb 23.
Page 37: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook

Page 38: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesImplementer’s Workbook

http://www.himss.org/asp/cds_workbook.asp

Page 39: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesSummary Issues

•Data capture/display/storage•EMR •central data repository

•Controlled, structured vocabulary•Knowledge representationKnowledge representation•Knowledge acquisition•Clinical event monitor: integrate the pieces for many different uses (clinical, research, administrative)

Page 40: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesSummary Issues

•How to represent (executable) guidelines?

•How to validate algorithm?

•How to validate implementation?

•Who does the validation?

Page 41: HL7 Decision Support Activities Rev 1 Draft Feb 23.

HL7 Decision Support ActivitiesHighlights

Arden Syntax

GELLO

vMR

Guidelines

Infobutton

Order Sets

Implementer’s Workbook


Related Documents