OpenMRS and OpenCDS: Potential for Collaboration

©2011, Kensaku Kawamoto©2011, Kensaku Kawamoto

OpenMRS and OpenCDS: Potential for CollaborationOpenMRS and OpenCDS: Potential for Collaboration

June 1, 2011

Kensaku Kawamoto, MD, PhD

Founder, OpenCDS (www.opencds.org) Co-Chair, HL7 Clinical Decision Support Work Group

Assistant Professor, Duke Center for Health Informatics8/11 - Assistant Prof., Dept. of Biomedical Informatics, Univ. of Utah8/11 - Director, Knowledge Management & Mobilization, Univ. of Utah

June 1, 2011


Founder, OpenCDS (www.opencds.org) Co-Chair, HL7 Clinical Decision Support Work Group

Assistant Professor, Duke Center for Health Informatics8/11 - Assistant Prof., Dept. of Biomedical Informatics, Univ. of Utah8/11 - Director, Knowledge Management & Mobilization, Univ. of Utah


Presentation OverviewPresentation Overview

BackgroundClinical decision support (CDS) - definition, examples,

evidence of effectiveness

ProblemNeed for scalable CDS

Potential SolutionStandards-based, open-source CDS services

OpenCDS

Discussion





OpenCDS

Discussion







OpenCDS

Discussion





OpenCDS

Discussion


Clinical Decision Support (CDS)Clinical Decision Support (CDS)

The act of providing clinicians, patients and other healthcare stakeholders with pertinent knowledge and/or person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care (Osheroff, J Am Med Inform Assoc, 2007)

The act of providing clinicians, patients and other healthcare stakeholders with pertinent knowledge and/or person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care (Osheroff, J Am Med Inform Assoc, 2007)


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.


Example Care Quality ReportingExample Care Quality Reporting

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


Example Care Manager AlertExample Care Manager Alert

Source: NC Medicaid. Lobach DF, Kawamoto K, et al. AMIA Annu Symp Proc. 2007;473-7.Source: NC Medicaid. Lobach DF, Kawamoto K, et al. AMIA Annu Symp Proc. 2007;473-7.


Example Patient Reminder LetterExample Patient Reminder Letter

Source: NC Medicaid. Lobach DF, Kawamoto K, et al. Proc / AMIA Annual Symp. 2007;473-7.Source: NC Medicaid. Lobach DF, Kawamoto K, et al. Proc / AMIA Annual Symp. 2007;473-7.


Example Medication Management ReportExample Medication Management Report

Source: Del Fiol G, Kawamoto K, et al. AMIA Proceedings, 2010.Source: Del Fiol G, Kawamoto K, et al. AMIA Proceedings, 2010.


Evidence from systematic reviewsActionable, computer-generated CDS provided

automatically at the point of care significantly improved care quality in >90% of RCTs (Kawamoto, BMJ, 2005)

CDS generally more effective than other QI approaches – including CME, audit and feedback, EBM guideline creation & dissemination, & financial incentives

Examples of effectiveness86% reduction in serious medication errors at Brigham

and Women’s Hospital (Bates, 1999)93.8% compliance with NCEP guidelines vs. 35.2%

compliance in academic cardiology clinic (Stamos, 2001)

Evidence from systematic reviewsActionable, computer-generated CDS provided

automatically at the point of care significantly improved care quality in >90% of RCTs (Kawamoto, BMJ, 2005)

CDS generally more effective than other QI approaches – including CME, audit and feedback, EBM guideline creation & dissemination, & financial incentives

Examples of effectiveness86% reduction in serious medication errors at Brigham

and Women’s Hospital (Bates, 1999)93.8% compliance with NCEP guidelines vs. 35.2%

compliance in academic cardiology clinic (Stamos, 2001)

Evidence of CDS EffectivenessEvidence of CDS Effectiveness



BackgroundCDS - definition, examples, evidence of effectiveness



OpenCDS

Discussion




OpenCDS

Discussion


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


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




ProblemNeed for scalable clinical decision support (CDS)


OpenCDS

Discussion




OpenCDS

Discussion


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

SEBASTIANDOD DDSS-KMRPartners ECRS / CDS Consortium

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

SEBASTIANDOD DDSS-KMRPartners ECRS / CDS Consortium

Why standards-based?To enable interoperability and scalability

Why open source?To foster adoption and collaboration


CDS Services – Architectural OverviewCDS Services – Architectural Overview

Decision Support 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

Standard Interface:HL7/OMG Decision Support Service Standard

(http://hssp-dss.wikispaces.com)

Standard Data Models: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 Data Models:HL7 Virtual Medical Record (vMR) Standard

[ http://wiki.hl7. org/index.php?title= Virtual_Medical_Record_(vMR) ]


CDS Services – ExampleCDS Services – Example



EHR SystemEHR System Patient Data Sources


Pt dataPt

dataCCDCCD

VMRVMREval.

ResultEval.

Result






OpenCDS

Discussion




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


Current OpenCDS CollaboratorsCurrent OpenCDS Collaborators University of Utah Duke University Veterans Health Admin. Intermountain Healthcare Univ. of NC at Chapel Hill Main Line Health Apelon, Inc. Keona Health Mass. General Hospital EBSCO Religent, Inc. IsoDynamic, Inc.

University of Utah Duke University Veterans Health Admin. Intermountain Healthcare Univ. of NC at Chapel Hill Main Line Health Apelon, Inc. Keona Health Mass. General Hospital EBSCO Religent, Inc. IsoDynamic, Inc.

Hospital Universitario Virgen del Rocío, Spain

MaRS Innovation, Canada SmartCare, Africa Emetra AS, Norway Visumpoint, LLC Genesys, LLC Df8health Under active discussions

with several other organizations and individuals

Hospital Universitario Virgen del Rocío, Spain

MaRS Innovation, Canada SmartCare, Africa Emetra AS, Norway Visumpoint, LLC Genesys, LLC Df8health Under active discussions

with several other organizations and individuals


Operational Deployment – Online TriageOperational Deployment – Online Triage


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

OpenCDSDrools Adapter


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


Authoring Platform

OpenCDSAdapter XOpenCDSAdapter X

Apelon Distributed Terminology System (DTS)



OpenCDS – Tour and DemoOpenCDS – Tour and Demo

DSS ClientDSS Client

OpenCDS DSS InterfaceOpenCDS DSS Interface






Authoring Platform


Authoring Platform




Terminology ManagementTerminology Management

External codes converted into internal OpenCDS concept(s) using terminology serviceE.g., ICD9CM 250.42

Diabetes mellitus with renal manifestationsDiabetes mellitusEndocrine disease

Separates terminology management from logic engineering

Uses Apelon DTS, but architecture supports use of other terminology services

External codes converted into internal OpenCDS concept(s) using terminology serviceE.g., ICD9CM 250.42

Diabetes mellitus with renal manifestationsDiabetes mellitusEndocrine disease

Separates terminology management from logic engineering

Uses Apelon DTS, but architecture supports use of other terminology services


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


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


Live DemoLive Demo






OpenCDS

Discussion




OpenCDS

Discussion


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 CDSFreely available under Apache 2.0 license

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 CDSFreely available under Apache 2.0 license


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


OpenMRS-OpenCDS CollaborationOpenMRS-OpenCDS Collaboration

Questions How can OpenCDS learn from OpenMRS’s success?

What is the current state of CDS within OpenMRS?

How could OpenCDS fit within OpenMRS’s overall direction?

Are there any “quick win” projects we can collaborate on?

Questions How can OpenCDS learn from OpenMRS’s success?

What is the current state of CDS within OpenMRS?

How could OpenCDS fit within OpenMRS’s overall direction?

Are there any “quick win” projects we can collaborate on?


AcknowledgementsAcknowledgements

Research supportNHGRI K01 HG004645 (PI: K. Kawamoto)

University of Utah Dept. of Biomedical Informatics

Numerous OpenCDS collaborators In particular, David Shields, University of Utah

Research supportNHGRI K01 HG004645 (PI: K. Kawamoto)

University of Utah Dept. of Biomedical Informatics

Numerous OpenCDS collaborators In particular, David Shields, University of Utah


www.opencds.orgwww.opencds.org


Thank You!Thank You!


[email protected]


[email protected]


Backup SlidesBackup Slides


NQF Measure 31 for Meaningful UseNQF Measure 31 for Meaningful Use


OpenCDS Implementation – Denom.OpenCDS Implementation – Denom.


OpenCDS Implementation – NumeratorOpenCDS Implementation – Numerator


OpenCDS Implement. – Underlying DetailsOpenCDS Implement. – Underlying Details


Testing EnvironmentTesting Environment


Batch Regression TestingBatch Regression Testing


DSS Invocation - WrapperDSS Invocation - Wrapper


DSS Invocation - PayloadDSS Invocation - Payload


DSS Response - WrapperDSS Response - Wrapper


DSS Response - PayloadDSS Response - Payload

OpenMRS and OpenCDS: Potential for Collaboration

Documents

OpenMRS and OpenCDS: Potential for Collaboration