medexter clinical decision support

Transcription

1 medexter Arden Syntax training course Klaus-Peter Adlassnig and Karsten Fehre Medexter Healthcare Borschkegasse 7/5 A-1090 Vienna Arden Syntax training course, Vienna, 17 June 2015

2 Computers in clinical medicine steps of natural progression step 1: patient administration admission, transfer, discharge, and billing medexter step 2: documentation of patients medical data in personal, or institution-wide, or national, or transnational electronic health records (EHRs) all media, life-long step 3: patient and hospital analytics simple statistics, quality measures and benchmarking, research databases, study support and recruitment population-specific analytics step 4: patient safety, quality assurance, evidence-based care patient-specific monitoring

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

4 medexter Clinical decision support for patient safety and quality assurance patients structured medical data: EHRs (local, national), Apps, diagnostic support alerts, reminders, to-do lists clinical interpretation, (tele)monitoring differential diagnostics rare diseases, rare syndromes further or redundant examinations diagnostic completeness (multi-morbidity) consensus-criteria-based evaluations disease classification and surveillance criteria prognostic prediction illness severity scores, prediction rules trend detection and visualization therapy advice drug alerts, reminders, calculations indication, contraindications, redundant medications, substitutions dosage calculations, drug-drug interactions, adverse drug events management of antimicrobial therapies, susceptibility and resistance rates open- and closed-loop control systems hospital management and quality benchmarking evidence-based reminders and processes computerized clinical guidelines, protocols, standard operating procedures healthcare-associated infection surveillance structured medical knowledge: rules, tables, trees, guidelines, scores, algorithms, ) T

5 studies in Colorado and Utah and in New York (1997) errors in the delivery of health care leading to the death of as many as 98,000 US citizens annually causes of errors error or delay in diagnosis failure errors to employ indicated tests use of outmoded tests or therapy failure to act on results of testing or monitoring error in the performance of a test, procedure, or operation error in administering the treatment error in the dose or method of using a drug avoidable delay in treatment or in responding to an abnormal test inappropriate prevention (not indicated) care failure of communication equipment failure prevention of errors we must systematically design safety into processes of care

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7 A holy grail of clinical informatics is scalable, interoperable clinical decision support. according to Kensaku Kawamoto HL7 Work Group Meeting, San Diego, CA, September 2011

8 medexter Arden Syntax: HL7- and ANSI-approved A standard language for writing situation-action rules, procedures, or knowledge bases that trigger results based on clinical events detected in patient data Each module, referred to as a medical logic module (MLM), contains sufficient knowledge to make a single decision extended by medical knowledge packages (MKPs) consisting of interconnected MLMs for complex continuous development since 1989 The Health Level Seven Arden Syntax for Medical Logic Systems, version 2.9 including fuzzy methodologies was approved by Health Level Seven (HL7) International and the American National Standards Institute (ANSI) in 2013 Version 2.10 including ArdenML, an XML-based representation of Arden Syntax MLMs was approved in 2014 healthcare industry and academic users