1. ©2010, Kensaku Kawamoto OpenCDS: an Open-Source, Standards-Based, Service-Oriented Framework for Scalable CDS AMIA 2010 Fall Symposium November 17, 2010 Kensaku Kawamoto, MD, PhD (kawam001@mc.duke.edu) Assistant Professor Duke Center for Health Informatics

2. ©2010, Kensaku Kawamoto Disclosure  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

3. ©2010, Kensaku Kawamoto Presentation Overview  Problem Need for scalable clinical decision support (CDS)  Potential Solution Standards-based, open-source CDS services  OpenCDS  Discussion

4. ©2010, Kensaku Kawamoto Presentation Overview  Problem Need for scalable clinical decision support (CDS)  Potential Solution Standards-based, open-source CDS services  OpenCDS  Discussion

5. ©2010, Kensaku Kawamoto The 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

6. ©2010, Kensaku Kawamoto The Need  Application-independent CDS resources that can be efficiently leveraged by diverse healthcare systems and health IT settings to improve patient health

7. ©2010, Kensaku Kawamoto Presentation Overview  Problem Need for scalable clinical decision support (CDS)  Potential Solution Standards-based, open-source CDS services  OpenCDS  Discussion

8. ©2010, Kensaku Kawamoto Rationale for Open, Standards-Based CDS Services  Why CDS services? Encapsulates knowledge in highly reusable components Supports multiple knowledge representation approaches Validated 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

9. ©2010, Kensaku Kawamoto CDS Services – Architectural Overview Decision Support Service Knowledge Modules Institution A Client Decision Support Apps Patient Data Sources Queries for required pt data Queries for required pt data Institution B Client Decision Support Apps Patient Data Sources Queries for required pt data Queries for required pt data Conclusions about patient Patient data, knowledge modules to use 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) ]

10. ©2010, Kensaku Kawamoto CDS Services – Example Decision Support Service EHR System Patient Data Sources Pt data CCD VMR Eval. Result

11. ©2010, Kensaku Kawamoto Presentation Overview  Problem Need for scalable clinical decision support (CDS)  Potential Solution Standards-based, open-source CDS services  OpenCDS  Discussion

12. ©2010, Kensaku Kawamoto OpenCDS  Goal Facilitate widespread availability of advanced CDS capabilities through open-source, collaborative development of standards-based DSS infrastructure, tooling, and high-value services  Methods Contribute through Open Health Tools Leverage open-source JBoss Drools rules engine Use 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  Methods Contribute through Open Health Tools Leverage open-source JBoss Drools rules engine Use modular architecture, enable iterative refinement, support multiple knowledge represent. approaches Develop all components required to author, test, and operationally support standards-compliant DSSs

13. ©2010, Kensaku Kawamoto Key Components  Standard interfaces and data models Reference implementation of HL7/OMG DSS interface vMR data model Data mappers (e.g., for CCD  vMR)  Reference DSS knowledge management framework JBoss Drools and associated authoring/knowledge management tools Full-featured terminology support A “domain specific language” for intuitive knowledge authoring  DSS “wrappers” for other CDS engines  Standard interfaces and data models Reference implementation of HL7/OMG DSS interface vMR data model Data mappers (e.g., for CCD  vMR)  Reference DSS knowledge management framework JBoss Drools and associated authoring/knowledge management tools Full-featured terminology support A “domain specific language” for intuitive knowledge authoring  DSS “wrappers” for other CDS engines

14. ©2010, Kensaku Kawamoto OpenCDS – Sample Topologies DSS Client OpenCDS DSS Interface OpenCDS Adapter X OpenCDS Adapter X OpenCDS Drools Adapter OpenCDS Drools Adapter OpenCDS Drools Engine CDS Engine/Service X (e.g., SEBASTIAN, KMR-DDSS, CDSC) CDS Engine/Service X (e.g., SEBASTIAN, KMR-DDSS, CDSC) OpenCDS Drools Knowledge Authoring Platform OpenCDS XML Knowledge Authoring Platform

15. ©2010, Kensaku Kawamoto Current 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 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

16. ©2010, Kensaku Kawamoto OpenCDS – Terminology Mgmt. with Apelon

17. ©2010, Kensaku Kawamoto OpenCDS – Terminology Mgmt. with Apelon

18. ©2010, Kensaku Kawamoto OpenCDS – Demo DSS Client OpenCDS DSS Interface OpenCDS Drools Adapter OpenCDS Drools Adapter OpenCDS Drools Engine OpenCDS Drools Knowledge Authoring Platform

19. ©2010, Kensaku Kawamoto Presentation Overview  Problem Need for scalable clinical decision support (CDS)  Potential Solution Standards-based, open-source CDS services  OpenCDS  Discussion

20. ©2010, Kensaku Kawamoto Key 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

21. ©2010, Kensaku Kawamoto Key Challenges and Potential Solutions ChallengePotential 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 Limited content availability  Provide federal funding for content development  Create an interoperable, standards-based market for such knowledge

22. ©2010, Kensaku Kawamoto Acknowledgements  Research support  NHGRI K01 HG004645 (PI: K. Kawamoto)  OpenCDS collaborators  Jack Bowie  Guilherme Del Fiol  Sandi Geary  Peter Haug  Kevin Hughes  Keith Larsen  Stratton Lloyd  Research support  NHGRI K01 HG004645 (PI: K. Kawamoto)  OpenCDS collaborators  Jack 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

23. ©2010, Kensaku Kawamoto www.opencds.org