1. The Morningside Initiative: Sharing of Knowledge and Methods for Clinical Decision Support Goals and approaches  Overcome resistance to sharing clinical decision support (CDS) knowledge, methods, and experience among organizations  Establish feasibility with small group of committed and experienced participants  Develop an organizational framework for collaboration  Intent to become self-sustaining  Establish functional requirements for content and tools to foster interoperability  Address knowledge acquisition, representation/ markup, curation, and localization  Drive process with use cases requiring SOA-based implementation  Develop representations and tools to overcome technical barriers  Adopt standards and drive development of ones that are lacking to foster interoperability  Identify and separate medical vs. business logic and facilitate localization and adaptation  Content foci  Begin with implemented CDS knowledge content and reuse » Initially diabetes rules and order sets » Subsequent goal of assimilating best practice knowledge Sponsorship  Convening and organizational support by TATRC  AMIA to provide organizational home for public-private partnership during early stages Structure  Steering Committee  Representatives of each organization  Processes and procedures for collaboration, pursuit of funding, growth of initiative, approach to long-term sustainability  Content Committee  Use-case driven focus on kinds of application needs, sources of knowledge, editing and approval process, application of knowledge  Technical Committee  Tools and resources to share, manage, represent, update knowledge Functional requirements  Driving use cases: Interoperable delivery of CDS at point of care through SOA interface  DoD AHLTA and NHIN interoperability node as first case » Goal of establishing a Knowledge Management Repository (KMR) and Guideline Workbench » To deliver CDS into AHLTA environment via SOA » Show interoperability on the NHIN DoD Federal Adapter  Overall model has 4 components 1.Knowledge Repository – the content » Maintaining stages of analysis, provenance of content » Target of standard representation with annotations enabling localization and adaptation to particular settings 2.Tools for knowledge acquisition, markup, management, and localization - the technology 3.Methods, ontologies, and schemas for sharability » Meta data tags, standards, templates, and vocabularies for representation and markup » Taxonomy of process/workflow/implementation contexts 4.SOA-based delivery – the execution environment » Not the focus of Morningside but provide the driving use cases American Medical Informatics Association; Arizona State University; Department of Defense Tri-Care Management Activity, Military Health System; Henry Ford Health System; Intermountain Healthcare; Kaiser Permanente; Partners Healthcare; Veterans Healthcare Administration Enterprise Knowledge Base Alerts Order sets Guidelines Reminders Shared Knowledge Base Enterprise Knowledge Base … Collaborative Knowledge Management RequirementDiscussion The shareable knowledge repository will be a multi- component model The decision support capabilities are divided into separate components for analysis and design. Repository featuresContains essential CDS components: Medical logic Metadata Workflow descriptors Documentation Conformance testing data Management ToolsIncludes tools for managing/maintaining knowledge resources: Knowledge authoring tools Metadata editors Focused and batch testing tools Sharability FeaturesContains features that support exchange of medical knowledge among dissimilar systems: Knowledge Interchange Format (KIF) Converters to and from KIF Conformance data exchange tools Execution EnvironmentWhile not an official part of Morningside, a basic runtime environment will ultimately be needed to support knowledge testing within the knowledge repository. External Knowledge Sources External Knowledge Sources