©2010, Kensaku Kawamoto OpenCDS: an Open-Source, Standards-Based, Service-Oriented Framework for...

OpenCDS: an Open-Source, Standards-Based, Service-Oriented

Framework for Scalable CDS

OpenCDS: an Open-Source, Standards-Based, Service-Oriented

Framework for Scalable CDS

AMIA 2010 Fall SymposiumNovember 17, 2010

Kensaku Kawamoto, MD, PhD (kawam001@mc.duke.edu)

Assistant ProfessorDuke Center for Health Informatics

AMIA 2010 Fall SymposiumNovember 17, 2010

Kensaku Kawamoto, MD, PhD (kawam001@mc.duke.edu)

Assistant ProfessorDuke Center for Health Informatics

DisclosureDisclosure

Dr. Kawamoto is a co-founder of Clinica Software, Inc., which provides open-source health IT solutions that utilize the Decision Support Service technology described in this presentation

Clinica will make any of its IP necessary for implementing the Decision Support Service standards discussed in this presentation available for free

Dr. Kawamoto is a co-founder of Clinica Software, Inc., which provides open-source health IT solutions that utilize the Decision Support Service technology described in this presentation

Clinica will make any of its IP necessary for implementing the Decision Support Service standards discussed in this presentation available for free

Presentation OverviewPresentation Overview

ProblemNeed for scalable clinical decision support (CDS)

Potential SolutionStandards-based, open-source CDS services

OpenCDS

Discussion

OpenCDS

Discussion

OpenCDS

Discussion

OpenCDS

Discussion

The ProblemThe Problem

Despite demonstrated effectiveness, CDS is not widely available

The lack of CDS availability is due in part to the tight coupling of CDS capabilities with specific institutions and health IT systems

Despite demonstrated effectiveness, CDS is not widely available

The lack of CDS availability is due in part to the tight coupling of CDS capabilities with specific institutions and health IT systems

The NeedThe Need

Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health

OpenCDS

Discussion

OpenCDS

Discussion

Rationale for Open, Standards-Based CDS ServicesRationale for Open, Standards-Based CDS Services

Why CDS services?Encapsulates knowledge in highly reusable componentsSupports multiple knowledge representation approachesValidated by several groups, including users of

SEBASTIAN CDS service (see panel in next session)

Why standards-based?To enable interoperability and scalability

Why open source?To foster adoption and collaboration

Why CDS services?Encapsulates knowledge in highly reusable componentsSupports multiple knowledge representation approachesValidated by several groups, including users of

SEBASTIAN CDS service (see panel in next session)

Why standards-based?To enable interoperability and scalability

Why open source?To foster adoption and collaboration

CDS Services – Architectural OverviewCDS Services – Architectural Overview

Decision Support Service

Knowledge Modules

Institution A Institution A

Client Decision Support Apps

Patient Data Sources

Queries for required ptdata

Institution B Institution B

Client Decision Support Apps

Queries for required ptdata

Conclusions about patientConclusions about patient

Patient data, knowledge modules to use

Trigger

Standard Interface:HL7/OMG Decision Support Service Standard

(http://hssp-dss.wikispaces.com)

Standard Service Payloads:HL7 Virtual Medical Record (vMR) Standard

[ http://wiki.hl7. org/index.php?title= Virtual_Medical_Record_(vMR) ]

Standard Interface:HL7/OMG Decision Support Service Standard

(http://hssp-dss.wikispaces.com)

Standard Service Payloads:HL7 Virtual Medical Record (vMR) Standard

[ http://wiki.hl7. org/index.php?title= Virtual_Medical_Record_(vMR) ]

CDS Services – ExampleCDS Services – Example

Decision Support Service

EHR SystemEHR System Patient Data Sources

Pt dataPt

dataCCDCCD

VMRVMREval.

ResultEval.

Result

OpenCDS

Discussion

OpenCDS

Discussion

OpenCDSOpenCDS

Goal Facilitate widespread availability of advanced CDS

capabilities through open-source, collaborative development of standards-based DSS infrastructure, tooling, and high-value services

MethodsContribute through Open Health ToolsLeverage open-source JBoss Drools rules engineUse modular architecture, enable iterative refinement,

support multiple knowledge represent. approaches Develop all components required to author, test, and

operationally support standards-compliant DSSs

Goal Facilitate widespread availability of advanced CDS

capabilities through open-source, collaborative development of standards-based DSS infrastructure, tooling, and high-value services

MethodsContribute through Open Health ToolsLeverage open-source JBoss Drools rules engineUse modular architecture, enable iterative refinement,

support multiple knowledge represent. approaches Develop all components required to author, test, and

operationally support standards-compliant DSSs

Key ComponentsKey Components

Standard interfaces and data modelsReference 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

authoring

DSS “wrappers” for other CDS engines

Standard interfaces and data modelsReference 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

authoring

DSS “wrappers” for other CDS engines

OpenCDS – Sample TopologiesOpenCDS – Sample Topologies

DSS ClientDSS Client

OpenCDS DSS InterfaceOpenCDS DSS Interface

OpenCDSAdapter XOpenCDSAdapter X

OpenCDSDrools Adapter

OpenCDS Drools Engine

CDS Engine/Service X (e.g., SEBASTIAN,KMR-DDSS, CDSC)

OpenCDS Drools Knowledge

Authoring Platform

OpenCDS XML Knowledge

Authoring Platform

OpenCDS XML Knowledge

Authoring Platform

Current OpenCDS CollaboratorsCurrent OpenCDS Collaborators Duke Center for Health Informatics

Ken Kawamoto (PI), David Shields, Guilherme Del Fiol Veterans Health Administration Intermountain Healthcare University of North Carolina at Chapel Hill Massachusetts General Hospital EBSCO Apelon, Inc. Clinica Software, Inc. IsoDynamic, Inc. Keona Health Visumpoint, LLC

Duke Center for Health InformaticsKen Kawamoto (PI), David Shields, Guilherme Del Fiol

Veterans Health Administration Intermountain Healthcare University of North Carolina at Chapel Hill Massachusetts General Hospital EBSCO Apelon, Inc. Clinica Software, Inc. IsoDynamic, Inc. Keona Health Visumpoint, LLC

OpenCDS – Terminology Mgmt. with ApelonOpenCDS – Terminology Mgmt. with Apelon

OpenCDS – DemoOpenCDS – Demo

DSS ClientDSS Client

OpenCDS DSS InterfaceOpenCDS DSS Interface

OpenCDSDrools Adapter

OpenCDS Drools Engine

Authoring Platform

OpenCDS

Discussion

OpenCDS

Discussion

Key Benefits of ApproachKey Benefits of Approach

Builds on robust open-source community and resources

Provides standard architectural framework for integrating various CDS knowledge resources

Supports full life cycle of knowledge authoring, testing, maintenance, and execution

Provides an open-source framework for collaboration and innovation in CDS

Builds on robust open-source community and resources

Provides standard architectural framework for integrating various CDS knowledge resources

Supports full life cycle of knowledge authoring, testing, maintenance, and execution

Provides an open-source framework for collaboration and innovation in CDS

Key Challenges and Potential SolutionsKey Challenges and Potential Solutions

Challenge Potential solutions

Increased effort required to develop and support knowledge resources for use in multiple contexts

Balance generalizability with resource realities Spread knowledge development cost over multiple deployment settings

Bottom line assessment: benefits >> challenges Bottom line assessment: benefits >> challenges

Limited content availability

Provide federal funding for content development Create an interoperable, standards-based market for such knowledge

AcknowledgementsAcknowledgements Research support

NHGRI K01 HG004645 (PI: K. Kawamoto)

OpenCDS collaboratorsJack Bowie

Guilherme Del Fiol

Sandi Geary

Peter Haug

Kevin Hughes

Keith Larsen

Stratton Lloyd

Research supportNHGRI K01 HG004645 (PI: K. Kawamoto)

OpenCDS collaboratorsJack Bowie

Guilherme Del Fiol

Sandi Geary

Peter Haug

Kevin Hughes

Keith Larsen

Stratton Lloyd

Kevin Meldrum

Javed Mostafa

Jonathan Nebeker

Oakkar Oakkar

Kraig Robson

David Shields

Jason Skowronski

Kevin Meldrum

Javed Mostafa

Jonathan Nebeker

Oakkar Oakkar

Kraig Robson

David Shields

Jason Skowronski

www.opencds.orgwww.opencds.org

©2010, Kensaku Kawamoto OpenCDS: an Open-Source, Standards-Based, Service-Oriented Framework for...

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