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Re: Decision Support Providers

Hi Rong,

I am also interested to hear a little more about your thoughts on further development. 

Since guidelines, ordersets and protocols all represent the optimal path fora notional patient, and will interact with the record for that patient, it makes sense to base the patient data aspects on the same structures as the actual patient data. 

In particular I would be interested to know your thought on how much additional metadata / ref model support might be required to support simple ordersets based on openEHR archetypes properly, leaving the more complex rules requirements to the side for the moment.

By orderset, I mean a simple collection of related instructions or requests for a common clinical scenario, such as 'Suspected MI'.

As well as the traditional static orderset and UI dialog, I am interested in driving data entry from such a typical ' clinical scenario' but in more of a narrative fashion. i.e start from a blank page and build up content from the scenario, some being Instructions, others observations and evaluations. I have had some experience of a real, if rudimentary, implementation and it seemed popular with clinicians. My interest in openEHR originally arose from looking for a generic information model to support this approach.

Ian

Dr Ian McNicoll
office / fax  +44(0)141 560 4657
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com
ian@mcmi.co.uk

Clinical Analyst  Ocean Informatics openEHR Archetype Editorial Group
Member BCS Primary Health Care SG Group www.phcsg.org / BCS Health Scotland



On 29 June 2010 13:57, Tony Shannon <tony.shannon@nhs.net> wrote:
Many thanks Rong,

The approach you outline which reuses archetypes and templates from EHR
models resonates as a logical way to tackle this.

John Halamka mentions in his blog...
"Thus, Anvita has defined clinical decision support (CDS) standards to
transmit decision support recommendations from the service provider back
to the EHR. I am unaware any widely implemented standards that do this
today. "

Can you comment on his quote/article?

Also can you say some more about the rules element of your work..

Many thanks,

Tony

Dr. Tony Shannon
Consultant in Emergency Medicine, Leeds Teaching Hospitals
Clinical Lead for Informatics,    Leeds Teaching Hospitals
Chair, Clinical Review Board, openEHR Foundation
+44.789.988 5068            tony.shannon@nhs.net


Rong Chen wrote:
> Hi Tony,
>
> I take the challenge to comment ;-)
>
> We start to see this kind of CDS services emerging now in Sweden.
> Web-services based drug interaction check is a good example of this.
> The difference is that the content (drug database) is available to the
> users. So it's not really a black-box. I doubt that a black-box CDS
> implementation will be very popular among the clinicians.
>
> I also think remote-service based CDS for raising single
> alerts/reminders can be useful in some limited scope but  will not
> scale up to provide more comprehensive CDS functions. I am more in
> favour of developing CDS content based on standardised EHR models so
> CDS applications can be implemented directly within EHRs.
>
> We start to exploring representing clinical guidelines using openEHR
> archetypes/templates and rules. Using EHR models to represent
> guidelines could give several potential benefits: 1) reuse of existing
> EHR content models as building blocks of guidelines; 2) increase
> interoperability between CDS applications and EHRs; 3) facilitate
> guideline compliance checking.
>
> More details can be found in our MIE2009 paper:
> http://www.imt.liu.se/~ronch/MIE2009_Representing_Lymphoma_Guideline_5page_v3.pdf
>
> Cheers,
> Rong
>
> On 25 June 2010 17:24, Shannon Tony (Leeds Teaching Hospitals NHS
> Trust) <tony.shannon@nhs.net> wrote:
>> FYI..
>>
>> A thought provoking post from John Halamka on decision support providers as service.
>> http://geekdoctor.blogspot.com/2010/06/decision-support-service-providers.html
>> Some of you might have complementary/alternative views as to how this might work within an openEHR enabled landscape...
>>
>> Rong
>> Would you like to comment?
>> Your recent work covered some of this key territory..
>>
>> Regards,
>>
>> Tony
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical@openehr.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
>

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