Clinical decision support systems. Medical knowledge packages

Size: px

Start display at page:

Download "Clinical decision support systems. Medical knowledge packages"

Melissa Norton
5 years ago
Views:

HL7-Standards zur klinischen Entscheidungsunterstützung Klaus-Peter Adlassnig Institut für Medizinische Experten- und Wissensbasierte Medexter Systeme Healthcare Zentrum für Medizinische Statistik,

1 HL7-Standards zur klinischen Entscheidungsunterstützung Klaus-Peter Adlassnig Institut für Medizinische Experten- und Wissensbasierte Medexter Systeme Healthcare Zentrum für Medizinische Statistik, Informatik und Intelligente Systeme Medizinische Universität Wien Spitalgasse 23 Medical Content Technical Frameworks A-1090 Wien und Medexter Healthcare GmbH Borschkegasse 7/5 A-1090 Wien Medical knowledge packages Knowledge packages for integration in: - HIS - Outpatient IS - PDMS - LIS - Lab analyzer - Physician s office - Telemedicine applications - Health portal Clinical decision support systems Stand-alone solutions: - Infection control systems - Lab decision support systems - Internal medicine decision support systems - Diagnostic & therapeutic reminder systems Inference systems Rule engines: - Arden Syntax Compiler & Engine & IDE & Server & host interface - Fuzzy Arden Syntax Compiler & Engine & IDE & Server & host interfaces HL7-Anwendergruppe Österreich, Jahrestagung, 21. März 2012, Wien Telemedical decision support services Teleiatros services: - Browser-based or direct server access to decision support systems - Writing and teleoperating customerspecific Arden Syntax & Fuzzy Arden Syntax MLMs Medical Services Medical consulting services Services: - Rule engine integration - SOAP & REST & XML & HL7 interoperability - Medical documentation & ontology services - Fuzzy-based medical text formalization

2 Computers in clinical medicine steps of natural progression step 1: patient administration admission, transfer, discharge, and billing of medical services step 2: documentation and access of patients structured medical data electronic health record: distributed, life-long step 3: patient data retrieval and analysis data warehouse, research databases, study support systems, quality assurance and reporting for a group of patients step 4: software systems for clinical decision support safety net, quality assurance and improvement for the individual patient

3 Medical information and knowledge-based systems patient s medical data symptoms signs test results clinical findings biosignals images diagnoses therapies nursing data standardization telecommunication chip cards information systems single patient medical statistics clustering & classification data & knowledge mining machine learning many patients induction clinical decision support medical expert systems deduction general knowledge general knowledge diagnosis therapy prognosis management physician s medical knowledge anatomy biochemistry physiology pathophysiology pathology nosology therapeutic knowledge disease management subjective experience intuition knowledge-based systems telemedicine integration telemedicine

4 Clinical decision support systems patients structured medical data diagnostic support clinical alerts, reminders, calculations data interpretation, (tele)monitoring differential diagnostic consultation rare diseases, rare syndromes further or redundant investigations pathological signs accounted for consensus-criteria-based evaluation definitions classification criteria prognostic prediction illness severity scores, prediction rules trend detection and visualization therapy advice drug alerts, reminders, calculations indication, contraindications, redundant medications, substitutions adverse drug events, interactions, dosage calculations, consequent orders management of antibiotics therapy (open-loop) control systems patient management guidelines guideline-based reminders computerized clinical guidelines, protocols, SOPs high-level patient and hospital analytics

5 Arden Syntax medical knowledge representation and processing

6 Arden Syntax and Health Level Seven (HL7) A standard language for writing situation-action rules that can trigger alerts based on abnormal clinical events detected by a clinical information system. van Bemmel, J.H., Musen, M.A. (eds.) (1997) Handbook of Medical Informatics, Springer-Verlag, Heidelberg, Glossary, p Each module, referred to as a Medical Logic Module (MLM), contains sufficient knowledge to make a single decision. extended by packages of MLMs for complex clinical decision support Contraindication alerts, management suggestions, data interpretations, treatment protocols, and diagnosis scores are examples of the health knowledge that can be represented using MLMs. extended by single and differential diagnostic support, temporal monitoring, control systems, computerized processing of clinical pathways and management guidelines The first version of the Arden Syntax (draft prepared at the Arden Homestead, New York, in 1989) was administered and issued by the American Society for Testing and Materials ASTM (1992, version 1.0; today 2.8, towards 2.9). Ownership was transferred to HL7 and the American National Standards Institute (ANSI) in 1999 with the approval of version 2.0.

General MLM Layout Maintenance Category Library Category Knowledge Category Resources Category Identify an MLM Data Types Operators Basic Operators Curly Braces

7 General MLM Layout Maintenance Category Library Category Knowledge Category Resources Category Identify an MLM Data Types Operators Basic Operators Curly Braces List Operators Logical Operators Comparison Operators String Operators Arithmetic Operators Other Operators Control Statements Call/Write Statements and Trigger

8 Arden-Syntax-based, service-oriented clinical decision support

9 Arden Syntax, Arden Syntax server, and health care information systems Integration KIS, MIS, PDMS, LIS, Praxissoftware, EHR, telemedizinische Anwendungen, Gesundheitsportale, Funktionalität * Daten- und Wissensbasen-Zentrum operativ: - Harmonisierung der Inputdaten - Arden-Syntax-MLMs - Erklärungskomponente erforschend: - Regellernen und -tuning - Daten- und Konzeptmining Reminder und Alarme, Monitoring, Surveillance, Entscheidungsunterstützung für Diagnostik und Therapiewahl,

10 health care information system medexter Arden Syntax server and software components Arden Syntax integrated development and test environment (IDE) including - Medical logic module (MLM) editor and authoring tool - Arden Syntax compiler (syntax versions 2.1, 2.5, 2.6, 2.7, and 2.8) - Arden Syntax engine - MLM test environment - MLM export component command-line Arden Syntax compiler results reporting tools knowledge administration data Arden Syntax development & test environment knowledge Arden Syntax server 1) interfaces 2) data & knowledge services center 1) integrated, local, or remote 2) local and web services, web frontend knowledge results Arden Syntax data rule engine web-services-based Arden Syntax server including - Arden Syntax engine - MLM manager - XML-protocol-based interfaces, e.g., SOAP, REST, and HL7 - a project-specific data and knowledge services center may be hosted Java libraries - Arden Syntax compiler - Arden Syntax engine Fuzzy Arden Syntax extension to fuzzy sets, operators, statements, and parallel execution

11 Crisp sets vs. fuzzy sets Y young threshold age U = [0, 120] yes/no decision Y U with Y = {( Y (x)/ x) x U} Y: U {0, 1} Y (x) = 0 x > threshold 1 x threshold x U Y young threshold age gradual transition U = [0, 120] Y U with Y = {(µ Y (x)/ x) x U} µ Y : U [0, 1] 1 x > threshold µ 1 + (0.04 x) 2 Y (x) = x U 1 x threshold

12 Interoperability

13 Monitoring of healthcare-associated infections

14 Interpretation von Hepatitis-Serologie-Befunden (I)

15 Interpretation of hepatitis serology test results (II)

16 Integration into i.s.h.med

17 GELLO/vMR Query and expression language / accessing a virtual medical record data model

18 GELLO/vMR and Health Level Seven (HL7) An object-oriented (OO) query and expression language for decision support Originally developed as a guideline expression language for query statements and decision rules Based on the existing object constraint language (OCL) and HL7 s reference information model (RIM) The GELLO language can be used to Build up queries to extract and manipulate data from medical records Construct decision criteria by building up expressions to reason about particular data features/values Proposal to use a virtual medical record (vmr) that provides a standard interface to heterogeneous medical record systems Includes using of terminologies/ontologies such as SNOMED CT and LOINC 2005 adopted as international standard by HL7 and the American National Standards Institute (ANSI)

Innovation project Standards-based CDS of the Veterans Health Administration, USA Web User Interface Innovation Initiative # 209 - Clinical Decision Support Transaction Diagram (3) Patient DFN Arden

19 Innovation project Standards-based CDS of the Veterans Health Administration, USA Web User Interface Innovation Initiative # Clinical Decision Support Transaction Diagram (3) Patient DFN Arden Syntax (3) Patient DFN (2) Patient DFN (3) Patient DFN GELLO/vMR (1) Patient Lookup (1) Patient Lookup (2) Patient DFN MDWS (4) return NHN VistA_1 (3) get NHN (3) get NHN (4) return NHN (4) return NHN VistA_2

20 Clinical decision support with Arden Syntax and GELLO/vMR CDS platforms based on Arden Syntax and Fuzzy Arden Syntax with data (sometimes) and knowledge services center and extended interoperability (webservices, XML data interfaces, libraries) integrated into or interconnected with CareVue and ICIP PDMSs (by Philips) monitoring and reporting of ICU-acquired infections (ICUs and NICUs) ICM (by Dräger) ICU decision support modules (Universitätsklinikum Erlangen) i.s.h.med HIS (by Siemens AG) dosing of immunosuppressive drugs for kidney transplant patients prediction of metastases in melanoma patients standard operating procedures for chemotherapy treatment of melanoma patients medico//s HIS (by Siemens AG) laboratory-based clinical reminders Soarian HIS (by Siemens AG) and Orbis HIS (by Agfa) hepatitis serology test interpretation VistA HIS (by Department of Veterans Affairs) service-oriented, standards-based CDS (clinical reminders and patient report cards) Monitoring adverse drug events (FFG project with Salzburger Universitätsklinikum) Teleiatros, iphone, ipad remote CDS, mhealth

medexter clinical decision support

medexter clinical decision support Arden-Syntax-Server Serviceorientierte Architektur für die klinische Entscheidungsunterstützung Klaus-Peter Adlassnig Medical Content Technical Frame Medexter Healthcare GmbH Borschkegasse 7/5 A-1090 Wien