Clinical Decision Support for Public Health Surveillance: Three Open Source Examples
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1 Clinical Decision Support for Public Health Surveillance: Three Open Source Examples CSTE Annual Conference Anchorage, AK June 21, 2016 Noam H. Arzt, PhD, FHIMSS Daryl Chertcoff HLN Consulting, LLC 1
2 Background Clinical Decision Support (CDS) tools important to support surveillance Software can be costly, hard to configure, test, and maintain Open source solutions becoming available Distinct advantages to Open Source 2
3 SWOT Analysis: Open Source Strengths No license fee to use No loss of access to source code if developer stops work Freedom to make/share changes Transparency in governance Enables more modular deployment Opportunities Joint development can reduce cost of enhancements & support Commercial vendors often provide solid support More modular systems might enable more Open Source component use Weaknesses Risk of detrimental source code forking Burden of enhancements may fall to individual users/organizations Software support may be harder to secure Threats Public health community will not financially support product development Public health community expects open source market to behave like commercial market Commercial vendor reactions 3
4 Common Foundation Three described here all use common framework and underlying CDS foundation and products OpenCDS ( HLN CDS Framework ( CDS Administration Tool (CAT) for: Rule authoring Testing Terminology maintenance 4
5 1: Immunization Calculation Engine (ICE) Service-oriented, standards-based immunization forecasting software system Evaluates a patient s immunization history and generates the appropriate immunization recommendations Can be deployed in diverse technical environments, centrally or distributed Designed to easily integrate with registries, surveillance systems, clinical systems (EHRs, PHRs) 5
6 2: Reportable Condition Knowledge Management System (RCKMS) Service-oriented, standards-based which allows EHR systems to submit initial electronic case reports to public health based on triggering event Evaluates conditions for reportability to a state/local jurisdiction and returns decision and instructions Expected to be deployed nationally on a shared platform with authoring tool for local jurisdictions to configure their rules 6
7 3: Decision Support for Data Segmentation (DS2) Part of ONC HITECH SHARP research project in a state-level HIE environment Uses CDS to identify and redact selected sensitive conditions from clinical summary documents Includes a web-based "inference analyzer" for visualizing the effectiveness and the impact of probabilistic redaction Includes a suite of related tools for creating, importing, and editing Continuity of Care (CCD) documents; testing redacted CCDs 7
8 Strategies for Success with Open Source in Public Health Begin to move systems to modularity and SOA Leverage widely-used Open Source products where feasible (e.g., Linux, PostgreSQL, HAPI, Mirth) Jointly develop/support more specialized products when necessary (e.g., examples cited earlier) Look beyond public health community for collaboration (e.g., EHRs, PHRs) Encourage one organization to maintain stewardship over and support each product to prevent detrimental forking (Managed Open Source) Recognize and manage any turbulence this may cause in the commercial product marketplace 8
9 Open Source Resources Open Source Initiative Open Source Electronic Health Record Alliance OSEHRA License Terms Document a_licensing_terms_v.1.0.pdf Draft Federal Source Code Policy 9
10 Contact Information Noam H. Arzt President, HLN Consulting, LLC (Voice) (FAX) Daryl Chertcoff Project Manager, HLN Consulting, LLC (Voice) 10
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