Presentation on theme: "OpenMRS and OpenCDS: Potential for Collaboration"— Presentation transcript:
1 OpenMRS and OpenCDS: Potential for Collaboration June 1, 2011Kensaku Kawamoto, MD, PhDFounder, OpenCDS (www.opencds.org)Co-Chair, HL7 Clinical Decision Support Work GroupAssistant Professor, Duke Center for Health Informatics8/11 - Assistant Prof., Dept. of Biomedical Informatics, Univ. of Utah8/11 - Director, Knowledge Management & Mobilization, Univ. of UtahSCT 14May
2 Presentation Overview BackgroundClinical decision support (CDS) - definition, examples, evidence of effectivenessProblemNeed for scalable CDSPotential SolutionStandards-based, open-source CDS servicesOpenCDSDiscussionSCT 14May
3 Presentation Overview BackgroundClinical decision support (CDS) - definition, examples, evidence of effectivenessProblemNeed for scalable CDSPotential SolutionStandards-based, open-source CDS servicesOpenCDSDiscussionSCT 14May
4 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)SCT 14May
5 Example Disease Management Reminders Source: Duke University Health System. Lobach DF, Kawamoto K, et al. Medinfo. 2007;861-5.
6 Example Care Quality Reporting Source: Duke University Health System.
7 Example Care Manager Alert Source: NC Medicaid. Lobach DF, Kawamoto K, et al. AMIA Annu Symp Proc. 2007;473-7.
8 Example Patient Reminder Letter Source: NC Medicaid. Lobach DF, Kawamoto K, et al. Proc / AMIA Annual Symp. 2007;473-7.
9 Example Medication Management Report Source: Del Fiol G, Kawamoto K, et al. AMIA Proceedings, 2010.
10 Evidence of CDS Effectiveness 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 incentivesExamples 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)SCT 14May
11 Presentation Overview BackgroundCDS - definition, examples, evidence of effectivenessProblemNeed for scalable CDSPotential SolutionStandards-based, open-source CDS servicesOpenCDSDiscussionSCT 14May
12 The ProblemDespite demonstrated effectiveness, CDS is not widely availableThe lack of CDS availability is due in part to the tight coupling of CDS capabilities with specific institutions and health IT systemsSCT 14May
13 The NeedApplication-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient healthSCT 14May
14 Presentation Overview BackgroundCDS - definition, examples, evidence of effectivenessProblemNeed for scalable clinical decision support (CDS)Potential SolutionStandards-based, open-source CDS servicesOpenCDSDiscussionSCT 14May
15 Rationale for Open, Standards-Based CDS Services Why CDS services?Encapsulates knowledge in highly reusable componentsSupports multiple knowledge representation approachesValidated by several groupsSEBASTIANDOD DDSS-KMRPartners ECRS / CDS ConsortiumWhy standards-based?To enable interoperability and scalabilityWhy open source?To foster adoption and collaborationSCT 14May
16 CDS Services – Architectural Overview Standard Interface:HL7/OMG Decision Support Service Standard(http://hssp-dss.wikispaces.com)Standard Data Models:HL7 Virtual Medical Record (vMR) Standard[ org/index.php?title= Virtual_Medical_Record_(vMR) ]Institution ATriggerQueries for required ptdataPatient Data SourcesPatient data,knowledge modules to useClient Decision Support AppsConclusions about patientInstitution BClient Decision Support AppsPatient Data SourcesQueries for required ptdataDecision Support ServiceKnowledge ModulesSCT 14May
17 Decision Support Service CDS Services – ExampleEval. ResultVMRCCDPt dataPatient Data SourcesDecision Support ServiceEHR SystemSCT 14May
18 Presentation Overview BackgroundCDS - definition, examples, evidence of effectivenessProblemNeed for scalable clinical decision support (CDS)Potential SolutionStandards-based, open-source CDS servicesOpenCDSDiscussionSCT 14May
19 OpenCDSGoalFacilitate widespread availability of advanced CDS capabilities through open-source, collaborative development of standards-based DSS infrastructure, tooling, and high-value servicesMethodsContribute through Open Health ToolsLeverage open-source JBoss Drools rules engineUse modular architecture, enable iterative refinement, support multiple knowledge represent. approachesDevelop all components required to author, test, and operationally support standards-compliant DSSs
20 Current OpenCDS Collaborators University of UtahDuke UniversityVeterans Health Admin.Intermountain HealthcareUniv. of NC at Chapel HillMain Line HealthApelon, Inc.Keona HealthMass. General HospitalEBSCOReligent, Inc.IsoDynamic, Inc.Hospital Universitario Virgen del Rocío, SpainMaRS Innovation, CanadaSmartCare, AfricaEmetra AS, NorwayVisumpoint, LLCGenesys, LLCDf8healthUnder active discussions with several other organizations and individuals
22 Key Components Standard interfaces and data models Reference 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 authoringDSS “wrappers” for other CDS engines
24 OpenCDS – Tour and Demo DSS Client OpenCDS DSS Interface OpenCDS Drools AdapterApelon Distributed Terminology System (DTS)OpenCDS Drools EngineOpenCDS Drools Knowledge Authoring Platform
25 Terminology Management External codes converted into internal OpenCDS concept(s) using terminology serviceE.g., ICD9CM Diabetes mellitus with renal manifestationsDiabetes mellitusEndocrine diseaseSeparates terminology management from logic engineeringUses Apelon DTS, but architecture supports use of other terminology services
26 OpenCDS – Terminology Mgmt. with Apelon SCT 14May
27 OpenCDS – Terminology Mgmt. with Apelon SCT 14May
29 Presentation Overview BackgroundCDS - definition, examples, evidence of effectivenessProblemNeed for scalable clinical decision support (CDS)Potential SolutionStandards-based, open-source CDS servicesOpenCDSDiscussionSCT 14May
30 Key Benefits of Approach Builds on robust open-source community and resourcesProvides standard architectural framework for integrating various CDS knowledge resourcesSupports full life cycle of knowledge authoring, testing, maintenance, and executionProvides an open-source framework for collaboration and innovation in CDSFreely available under Apache 2.0 licenseSCT 14May
31 Key Challenges and Potential Solutions Increased effort required to develop and support knowledge resources for use in multiple contextsBalance generalizability with resource realitiesSpread knowledge development cost over multiple deployment settingsLimited content availabilityProvide federal funding for content developmentCreate an interoperable, standards-based market for such knowledgeBottom line assessment: benefits >> challengesSCT 14May
32 OpenMRS-OpenCDS Collaboration QuestionsHow 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?SCT 14May
33 Acknowledgements Research support Numerous OpenCDS collaborators NHGRI K01 HG (PI: K. Kawamoto)University of Utah Dept. of Biomedical InformaticsNumerous OpenCDS collaboratorsIn particular, David Shields, University of UtahSCT 14May