RE: Decision Support Providers

[Kensaku Kawamoto <kawam001@mc.duke.edu>]

Hi Everyone,

My apologies if you receive this message
twice -- I got a "message too large" error from the list-serv,
so I am re-posting without attachments.

I'm new to the OpenEHR list, but thought
I'd comment on this discussion with hopefully some relevant insights.

I am a co-chair of the HL7 Clinical
Decision Support (CDS) Work Group, and we have been working on several
relevant standards around CDS services.  Of note, these standards
are based on our operational use of this approach, including for a point-of-care
chronic disease management system used by approximately 500 clinicians
at Duke University Health System; a population health management system
that supports care managers, clinicians, and patients within North Carolina
Medicaid; and systems that remotely access our CDS service from Argentina
and from Massachusetts.

Below are several standards and resources
that may be relevant to this discussion thread:

> The HL7 Decision Support Service
draft standard, which provides a common functional specification for
how CDS services should work:http://www.hl7.org/v3ballot2009jan/html/infrastructure/dss/dss.htm

> The OMG Decision Support Service
draft standard (soon to be a full normative standard), which was adopted
in December 2009 and provides an implementable Web service specification
based on the HL7 standard: 
http://hssp-dss.wikispaces.com/omg_specification

Of note, both the HL7 and OMG Decision
Support Service standards support the use of semantic payloads defined
outside of HL7, such as OpenEHR Archetypes.

> As the above standards specify
interaction models but not the semantic payloads, we are also working on
a specification for service input and output data known as the HL7 virtual
medical record (vMR) standard.  This standard will be compatible
with using HL7 v3 information models as the input, but we also intend to
allow the use of other sources of data (e.g., CCR, HL7 V2 messages, and
hopefully OpenEHR Archetypes).  This work is based on an an analysis
of CDS data needs across 20 institutions from 4 countries, and it underwent
initial balloting last month.  More information on this work can be
found at the following wiki: http://wiki.hl7.org/index.php?title=Virtual_Medical_Record_(vMR).
 Of note, myself and other members of this project team have been
following some of the comments regarding this project posted on the OpenEHR
lists, and have found them to be quite helpful and aligned with some of
the issues we are grappling with.  We are trying to learn more about
OpenEHR to see how we can leverage it for this emerging HL7 standard, and
we hope to learn more from the expertise available in the OpenEHR community.

> A presentation I recently gave
that provides an overview of these standards and describes a recently
initiatied effort to develop an open-source, IP-free reference implementation
compliant with the HL7/OMG Decision Support Service standard.  This
system will be an evolution from the currently operational CDS service
I developed known as SEBASTIAN, with the key differentiators being: (1)
full standards compliance, (2) use of an open-source rules authoring, management,
and execution environment (Drools), and (3) adoption of an open-source,
IP-free model to facilitate collaboration and adoption.  I am spear-heading
this multi-institutional effort.
http://community.jboss.org/servlet/JiveServlet/download/14964-115-12135/Kawamoto%20K%20--%20CDS%20with%20HL7%20and%20Drools,%20v03.ppt

> A recent JAMIA article describing
the broader HL7-OMG effort to develop standard service interface specifications
for healthcare:
http://jamia.bmj.com/content/16/6/874.abstract

> A paper on how this kind of a standards-based,
service-oriented approach to CDS could be leveraged to enable personalized
medicine in a highly scalable manner.  I have a strong interest
in this area and am currently supported by the National Human Genome Research
Institute to explore how to enable scalable CDS for genomic and personalized
medicine.
http://www.biomedcentral.com/1472-6947/9/17

> We also have two potentially relevant
papers pending e-publication, one analyzing the landscape of standards
related to CDS (including for CDS services) and another providing an experience-based
analysis of the pros and cons of using a services-based approach to CDS.
 Once these manuscripts are publicly available, I will plan to post
them to the list for reference.

Thanks!
Ken Kawamoto

HL7 CDS Work Group Co-Chair
Project Lead, HL7/OMG Decision Support
Services project and HL7 Virtual Medical Record project

=======================================
Kensaku Kawamoto, M.D., Ph.D.
Assistant Professor
Division of Clinical Informatics
Department of Community and Family Medicine
Member, Institute for Genome Sciences & Policy
Member, Center for Health Informatics
Duke University
Tel: (919)684-2340
Fax: (919)684-8675

"Shannon Tony (Leeds Teaching Hospitals NHS Trust)" <tony.shannon@nhs.net>
Sent by: openehr-clinical-bounces@openehr.org

07/05/2010 03:12 AM

Please respond to
For openEHR clinical discussions <openehr-clinical@openehr.org>

To	"timothywayne.cook@gmail.com" <timothywayne.cook@gmail.com>, For openEHR        clinical discussions <openehr-clinical@openehr.org>
cc
Subject	RE: Decision Support Providers

Thanks Tim

Sounds like that work was ahead of its time. I hadn't come across it before.
Any key conclusions you drew from that work?

Regards,

Tony

________________________________________
From: openehr-clinical-bounces@openehr.org [openehr-clinical-bounces@openehr.org]
On Behalf Of Tim Cook [timothywayne.cook@gmail.com]
Sent: 29 June 2010 16:32
To: For openEHR clinical discussions
Subject: Re: Decision Support Providers

On Tue, 2010-06-29 at 13:57 +0100, Tony Shannon wrote:
> Many thanks Rong,
>
> The approach you outline which reuses archetypes and templates from
EHR
> models resonates as a logical way to tackle this.

Though it was redesigned to use CDA in order to hopefully gain
acceptance with vendors EGADSS was originally designed (by me) for use
with archetypes and templates.  The implemented concepts and possibly
the source code could be reused.

http://egadss.sourceforge.net/

HTH,
Tim


>
> 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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