CLINICAL DECISION SUPPORT WITH DECISION MODEL AND NOTATION (DMN)

Transcription

1 CLINICAL DECISION SUPPORT WITH DECISION MODEL AND NOTATION (DMN) Presenter: Vipul Kashyap, Matteo Mortari Presenter s title: Director, Clinical Information Systems, Date: May 8 th, 2018 *Special Thanks to Denis Gagne, Simon Ringuette from Trisotech for DMN Authoring support

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4 Outline Clinical Decision Support (CDS) and LACE Score CDS Lifecycle Clinical Informaticist (CI)/Business Analyst (BA) Friendly Decision Modeling Notation Demo

5 Clinical Decision Support and LACE Score Clinical Decision Support: Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. LACE Score: Identifies patients that are at risk for readmission or death within 30 days of discharge. Output of a CDS knowledge base (illustrated in this presentation) which helps a care coordinator make decisions about the care plan and outreach for a discharged patient. Next: The process by which CDS logic is created and tested

6 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

7 Clinical Informaticist/Business Analyst Friendly Creation of CDS Logic by CIs/BAs as opposed to IT Developers Ease of Understanding by Subject Matter Experts (SMEs) a concise substitute to lengthy requirements documents Testing and Refinement of CDS Logic by CIs/Bas Facilities for Re-use: Decisions, Business Knowledge Models, Decision Services Audit and Analysis of Clinical Decisions and Recommendations

8 Decision Model and Notation Decision Requirements Diagram (DRD) Decision Node Input Node Business Knowledge Model

9 DMN examples of boxed expressions and FEEL examples

10 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

11 Rules Authoring: Current State

12 Rules Authoring: Current State Separate Project File for Charleson Score Need to download Spreadsheet for understanding Logic!

13 Decision Sub-Decision Business Knowledge Model Input Decision Content

14 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

15 Test and Refine Model Specify Test Data

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18 Current Encounter with Length of Stay = 6 Days

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21 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

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25 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

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27 All related sub All related sub-decisions are also retrieved are also retrieved!

28 Reusable Encapsulated Service

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30 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

31 Decision Content

32 Content Decision Node Can be re-used Across Models!!

33 Content of a Content Decision Node used in Decision Logic

34 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

35 Reusable Function Decision Node Invoking that function

36 Invokes

37 CDS Lifecycle CDS Logic Requirements Operational Evaluation of Model (False Positives, Negatives) Deploy Model for Execution + Operational Auditing Publish DMN Model/ Specify Metadata for Cataloging Reuse: Enterprise Data Model for Logic Data Elements Refine and Test DMN Model Pre-existing Decisions, Decision Services Author DMN Model Pre-curated Concept Sets (e.g., Diabetes) Parameterized Functions

38 Payload Model

39 Model Auditing

40 Conclusions and Future Work Operational Deployment of DMN Models LACE Score Acute Kidney Injury DMN Training for Clinical Informaticists/Business Analysts DMN as an Abstract Logic Layer Rules PMML models SQL Queries Event-based DMN

41 Acknowledgments Vish Anantraman Harikrishna Nandigam Amitabh Nayak

42 THANK YOU plus.google.com/+redhat facebook.com/redhatinc linkedin.com/company/red-hat twitter.com/redhat youtube.com/user/redhatvideos