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November 4, 2012 American Medical Informatics Association Fall Symposium Kensaku Kawamoto, MD, PhD

HL7 Decision Support Service (DSS) and Virtual Medical Record (vMR) Standards, and OpenCDS Open-Source Implementation. November 4, 2012 American Medical Informatics Association Fall Symposium Kensaku Kawamoto, MD, PhD Director, Knowledge Management and Mobilization, Univ. of Utah

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November 4, 2012 American Medical Informatics Association Fall Symposium Kensaku Kawamoto, MD, PhD

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  1. HL7 Decision Support Service (DSS) and Virtual Medical Record (vMR) Standards, and OpenCDS Open-Source Implementation November 4, 2012 American Medical Informatics Association Fall Symposium Kensaku Kawamoto, MD, PhD Director, Knowledge Management and Mobilization, Univ. of Utah Assistant Professor, Dept. of Biomedical Informatics, Univ. of Utah Co-Chair, HL7 Clinical Decision Support Work Group Founder, OpenCDS (www.opencds.org) kensaku.kawamoto@utah.edu

  2. Two Primary Approaches to CDS Sharing Standardization of knowledge representation format Premise: a standard knowledge artifact can be specified once and then leveraged by multiple EHR systems E.g., HL7 Arden, HL7 GELLO, HL7 Order Set, HL7 HQMF Sharing of CDS capability via standard interface Premise: CDS capabilities can be leveraged by multiple EHR systems through the use of a standard interface HL7 Infobutton, Both approaches need standard information models HL7 CCD, ASTM CCR, HITSP C32, etc. HL7 Virtual Medical Record HL7 Decision Support Service

  3. HL7 Decision Support Service (DSS) Standard

  4. Decision Support Service (DSS) – Overview Function: Evaluates patient data (inputs) and returns machine-interpretable conclusions (outputs) Normative HL7/ANSI standard

  5. DSS – Architectural Overview Patient data (e.g., care summary), modules to use Patient Data Sources Patient Data Sources Conclusions about patient Institution B Queries for required pt data Queries for required pt data Client Decision Support Apps Client Decision Support Apps Knowledge Modules Institution A Trigger Decision Support Service

  6. DSS – Primary Service Operations 1. Evaluate Patient Modules to use, required data Patient-specific evaluation results 2. Find Knowledge Modules 3. Get Data Requirements 4. Get Evaluation Result Semantics Modules of interest Search criteria Module of interest Modules meeting criteria Data requirements Output specification Decision Support Service Service Client

  7. HL7 DSS – Tools and Use Tools OpenCDS: open-source reference implementation Known users of DSS standard (partial list) Alabama Department of Public Health CDS Consortium/Partners HealthCare eClinicalWorks HLN Consulting, LLC HP Advanced Federal Healthcare Innovation Lab New York City Department of Health & Mental Hygiene University of Utah Health Care VHA Knowledge Based Systems Office

  8. HL7 Virtual Medical Record (vMR) Standard

  9. vMR Goal • Provide common information model upon which interoperable clinical decision support resources (e.g., rules) can be developed

  10. Project History • Analysis of data required by 20 CDS systems from 4 countries (Kawamoto et al., AMIA 2010) • Refinement of vMR via implementation within OpenCDS • Release 1 adopted in Sept. 2011 as HL7 standard • Release 2 being prepared for ballot

  11. vMR Problem Model

  12. Why Not Just Use the CCD as the vMR? CCD does not include all needed information E.g., Family history model suitable for CDS CCD is not sufficiently intuitive for direct use by CDS knowledge authors

  13. Problem Model – CCD vs. VMR

  14. HL7 vMR – Tools and Use Tools OpenCDS: open-source reference implementation Known users of vMR standard (partial list) Alabama Department of Public Health eClinicalWorks HLN Consulting, LLC HP Advanced Federal Healthcare Innovation Lab Intermountain Healthcare Homer Warner Center Medical-Objects New York City Department of Health & Mental Hygiene University of Utah Health Care VHA Knowledge Based Systems Office

  15. OpenCDS

  16. OpenCDS (www.opencds.org) • Provides a reference implementation of the HL7 DSS and vMR standards • 1.1 release freely available under Apache 2 open-source license

  17. Featured Collaborators

  18. OpenCDS Knowledge Authoring - Rules

  19. OpenCDS Knowledge Authoring – Decision Tables

  20. OpenCDS Knowl. Authoring – Flow Diagrams

  21. www.opencds.org

  22. Thank You! For more on OpenCDS at AMIA 2012: • Poster Session 1 (Mon 5 – 6:30pm) • Poster Session 2 (Tue 5 – 6:30pm) • Panel S34: From Guidelines to CDS (Mon 3:30 – 5pm) Contact Information: Kensaku Kawamoto, MD, PhD Director, Knowledge Management and Mobilization Assistant Professor, Department of Biomedical Informatics University of Utah kensaku.kawamoto@utah.edu

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