Clinical Decision Support Product Area Rong Chen MD PhD Chief Medical Informatics Officer CAMBIO HEALTHCARE SYSTEMS 2015-6-16 WWW.CAMBIOHEALTHCARE.CO.UK 1
Patient CAMBIO HEALTHCARE SYSTEMS
Core Assumptions The complexity of modern medicine exceeds the inherent limitations of the unaided human mind. ~ David M. Eddy, MD, Ph.D.... man is not perfectible. There are limits to man s capabilities as an information processor that assure the occurrence of random errors in his activities. ~ Clement J. McDonald, MD CAMBIO HEALTHCARE SYSTEMS 2015-01-21 WWW.CAMBIO.SE 3
Change of clinical practices Clinical outcomes Awareness of new knowledge Evidence-based clinical guidelines Takes 17 years in average CAMBIO HEALTHCARE SYSTEMS
Product solution Studies for monitoring Knowledge Manager Apps for interventions Open standards & Light-weight technologies Closed loop system for improvement CAMBIO HEALTHCARE SYSTEMS 27/05/2014 WWW.CAMBIOHEALTHCARE.CO.UK 5
General requirements of GDL Formal language to express clinical logic Machine readable format, standards-based Agnostic to natural languages Add/update translations without invalidating logic Agnostic to reference terminologies Easy to change term bindings EHR model independent Reuse of common EHR models both for input and output Rules for single decision making But ready to be combined for more complex decision making Coherent and reusable For improved reusability and maintainability Rapid development / release cycles Independent of main EHR product Cambio Healthcare Systems AB -6-2015-12-02
openehr Archetype??? => GDL SNOMED CT, ICD10, ATC, A L Rector PD Johnson S Tu C Wroe and J Rogers (2001) Interface of inference models with concept and medical record models. in S Quaglini, P Barahona and S Andreassen (eds) Proc Artificial Intelligence in Medicine Europe (AIME-2001 ) Springer:314-323 Cambio Healthcare Systems AB -7-2015-12-02
Guideline Definition Language (GDL) A minimum language to glue together archetypes, terminologies and rules Three Pillars Bindings between archetype elements and variables in the rules Rule expressions easily converted to industry rule engine languages Bindings between local concepts used in the rules and concepts from reference terminologies Cambio Healthcare Systems AB -8-2015-12-02
GDL Design Released through openehr Cambio Healthcare Systems AB -9-2015-12-02
Updated GDL Design Specifications http://www.openehr.org/releases/cds/latest/docs/gdl/gdl.html Cambio Healthcare Systems AB -10-2015-12-02
Open Source GDL Ref Impl & Editor CAMBIO HEALTHCARE SYSTEMS 27/05/2014 WWW.CAMBIOHEALTHCARE.CO.UK 11
Cambio CDS Knowledge Manager A repository of standard-based, fully structured clinical models for advanced clinical applications. CAMBIO HEALTHCARE SYSTEMS 14/10/2015 www.cambiohealthcare.co.uk 12
Cambio CDS Dashboard An overview of healthcare data and clinical performance in terms of treatment adherences to practice guidelines, quality indicators and healthcare outcome measurements. CAMBIO HEALTHCARE SYSTEMS 14/10/2015 www.cambiohealthcare.co.uk 13
Stroke Prevention in Atrial Fibrillation Atrial fibrillation (AF), most common arrhythmia in the heart. 10% prevalence in elderly population. Untreated AF has 4.5% chance of stroke yearly, and causes more severe and subtle strokes. Known treatment reduces strokes chance by 70% National treatment compliance is about 42% in 2013 study Increase from 42% to 75% will prevent about 3000 strokes yearly About 150 preventable stroke in Region Östergötland yearly CAMBIO HEALTHCARE SYSTEMS 27/05/2014 WWW.CAMBIOHEALTHCARE.CO.UK 14
Knowledge of Stroke Prevention in AF ESC Guidelines on the Management of Atrial Fibrillation, European Heart Journal (2010) 31, 2369 2429. 2012 focused update of the ESC Guidelines for the Management of atrial fibrillation, European Heart Journal (2012) 33, 2719 2747 CAMBIO HEALTHCARE SYSTEMS
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About 24 million SEK saving for 10% compliance improvement in Östergötland (half million population) yearly http://www.tlv.se/upload/medicinteknik/kunskapsunderlag_datoriserat_kliniskt_beslutsstod_str okeriskvardering.pdf CAMBIO HEALTHCARE SYSTEMS 27/05/2014 WWW.CAMBIOHEALTHCARE.CO.UK 18
Summary CDS product is independent of COSMIC Completely separated from the COSMIC Roadmap Open & flexible platform Based on standards, light-weight technologies Agnostic to natural languages and clinical areas Based on sharable CDS logic and modules Semantic EHR standards are prerequisites Necessary to share foundational models (archetypes) Sharing across countries and organizations a possibility CAMBIO HEALTHCARE SYSTEMS 27/05/2014 WWW.CAMBIOHEALTHCARE.CO.UK 19