Re: Decision Support Providers
Thanks Ken, Its very good to see your work in this area. Your BMC paper makes a good case for greater collaboration on the infrastructure required to underpin all the many ambitions that surround decision support, personalised medicine, links to genomics etc.. Very glad to see your open source reference implementation approach to the challenge. I think there is much merit in that approach. You may be interested in Opereffa as a related openEHR effort. http://opereffa.chime.ucl.ac.uk/ Your openness to openEHR archetypes is also welcome. I think you will find real value within, have you seen the openEHR clinical knowledge manager already? http://openehr.org/knowledge You may have questions of the list about archetypes.. Rong, Would you be able to comment on the overlap between your openEHR work on DSS and Kens..? Regards, 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 Kensaku Kawamoto wrote: > > 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. > <http://wiki.hl7.org/index.php?title=Virtual_Medical_Record_(vMR)> > > > 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 > > > > > > > -- > > > > > > > ******************************************************************************************************************** > > > > This message may contain confidential information. If you are not > the > intended recipient please inform the > > sender that you have received the message in error before deleting > it. > > Please do not disclose, copy or distribute information in this > e-mail > or take any action in reliance on its contents: > > to do so is strictly prohibited and may be unlawful. > > > > Thank you for your co-operation. > > > > NHSmail is the secure email and directory service available for all > NHS staff in England and Scotland > > NHSmail is approved for exchanging patient data and other sensitive > information with NHSmail and GSI recipients > > NHSmail provides an email address for your career in the NHS and > can > be accessed anywhere > > For more information and to find out how you can switch, visit > www.connectingforhealth.nhs.uk/nhsmail > > > > > ******************************************************************************************************************** > > > > > > _______________________________________________ > > openEHR-clinical mailing list > > openEHR-clinical@openehr.org > > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > -- > *************************************************************** > Timothy Cook, MSc > > LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook > Skype ID == (upon request) > Academic.Edu Profile: http://uff.academia.edu/TimothyCook > > You may get my Public GPG key from popular keyservers or > from this link http://timothywayne.cook.googlepages.com/home > > > ******************************************************************************************************************** > > This message may contain confidential information. If you are not the > intended recipient please inform the > sender that you have received the message in error before deleting it. > Please do not disclose, copy or distribute information in this e-mail > or > take any action in reliance on its contents: > to do so is strictly prohibited and may be unlawful. > > Thank you for your co-operation. > > NHSmail is the secure email and directory service available for all > NHS > staff in England and Scotland > NHSmail is approved for exchanging patient data and other sensitive > information with NHSmail and GSI recipients > NHSmail provides an email address for your career in the NHS and can > be > accessed anywhere > For more information and to find out how you can switch, visit > www.connectingforhealth.nhs.uk/nhsmail > > ******************************************************************************************************************** > > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical@openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > -- ******************************************************************************************************************** This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSI recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail ******************************************************************************************************************** _______________________________________________ openEHR-clinical mailing list openEHR-clinical@openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical