Virtual Medical Record Implementation for Enhancing Clinical Decision Support

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1 Virtual Medical Record Implementation for Enhancing Clinical Decision Support Valentin Gomoi, PhD student Daniel Dragu, PhD student Vasile Stoicu-Tivadar, Prof. dr. ing. Faculty of Automation and Computers University Politehnica Timişoara Timișoara, Romania

2 Goal: Increase access to data for Clinical Decision Support Systems Based on: - HL7 Standards (CDA, vmr) - a topic map as knowledge source

3 Content: 1. Introduction, Motivation 2. System Architecture 2.1 Tools and standards 2.2 Inference engine 2.3 HL7 CDA Component (Retrieve data) 2.4 Data manager 3. TM-VMR 3.1 Implementation 3.2 Communication 3.3 Results

4 1 Guidelines? Protocols? Recommendations? Medical Guideline: - systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. Medical Protocol: - provides the information on duration, dosages, procedures which were omitted in the guideline. Medical Recommendations: - suggestions representing the result of the inference based on medical guidelines.

5 1 Why using Clinical Decision Support Systems? local adaptation of the guidelines compliance with the protocols and guidelines standardization of medical practice faster implementation of new practice better visualisation of medical information

6 Existing solutions for Clinical Decisions Support (CDS) Approaches regarding the implementation of the computer-based guidelines and protocols: Asbru, PROforma, DeGeL, Arden Syntax, GUIDE. Egadss 1

7 Local adaptation and data retrieving problems ü Existing solution present low adaptability Adaptable solutions need standards for: - patient data transfer and representation HL7 CDA, vmr 1 - medical rules representation Arden Syntax

8 2 System Architecture for increasing CDS interoperability TM-vMR Data Manager Inference engine Egadss HL7 CDA Components

9 vmr-tm 2.4 Data Manager Is used to ensure the communication between the other system components being called and calling different web services Has the roles to respond at different requests from: interface, medical data sources (HL7 CDA Components), inference engine

10 2 System Architecture for increasing CDS interoperability TM-vMR Data Manager Inference engine Egadss HL7 CDA Components

11 Inference (Egadss): Egadss- is a clinical decision support system Uses: - Arden Syntax (MLM) for the representation of medical rules; - HL7 CDA level 3 messages as input; - HL7 CDA level 2 messages as output; - Clips as inference engine; 2.2

12 2 System Architecture for increasing CDS interoperability TM-vMR Data Manager Inference engine Egadss HL7 CDA Components

13 2.3 HL7 CDA Component - extracts information from different databases; - represents information in HL7 CDA format; - implementation: Visual Studio.Net 2008, C# language; - access to more complex information;

14 2 System Architecture for increasing CDS interoperability TM-vMR Data Manager Inference engine Egadss HL7 CDA Components

15 3 TM-vMR representing vmr with TM vmr standard for the representation of medical knowledge used in different CDS systems TM encoding knowledge and connecting this encoded knowledge to relevant information resources

16 3 vmr standard model appeared as a necessity for the interoperability between different CDS and data sources contains 131 medical data elements improves communication between CDS systems and other medical systems

17 3 TM Ø ISO/IEC 13250:2003; Ø a semantic technology; Ø knowledge representation; Ø Ø Ø Ø Ø to qualify the content of topics; to link topics together; to filter information; to structure unstructured information sets; to merge topics and topic maps;

18 3.1 TM-vMR Implementation Is realized by using Topincs open source software Steps o create a topic type for every vmr class within the vmr atomic terms; o model all relationships within the vmr o define the serialization names for all terms within the schema

19 3.1 TM-vMR Associations for vmr elements Occurrences for vmr elements

20 3.2 TM-vMR with CDS Comunication through tobjects topic map objects in Topincs are called tobject tobjects represent an data element from the vmr tobjects allow the insertion, deletion, modification and many other types of special functions ()

21 3.2 TM-vMR with CDS Comunication through tobjects realized with the help of the web services The web services interact with the vmr through tobjects client server architecture services are consumed from the Data Manager NuSOAP PHP technology communication over HTTPS

22 TM-vMR Results vmr element 3.3 Functions to work with the vmr element trough tobjects

23 3.3 TM-vMR - benefits o connection of any vmr compatible CDS o extensibility for vmr DAM o (web) services especially designed for CDS developers o easy to use knowledge base o development of a collaborative solution for the capturing of medical information

24 TESTING TM-vMR The test was done for the management of diabetes used in Timișoara Emergency County Clinical Hospital, Timisoara: - MLMs where created containing the medical rules - PHP Web Services to extract the needed patient data from the TM-vMR 3.3 Patient data needed for the

25 Medical Rules in Arden Syntax for the prescription of NaCl or glucose 3.3

26 TESTING TM-vMR The test was done for the management of diabetes used in Timișoara Emergency County Clinical Hospital, Timisoara: - MLMs where created containing the medical rules - PHP Web Services to extract the needed patient data from the TM-vMR 3.3 Patient data needed for the

27 3.3 PHP web services to access patient data trough tobjects Creating to the needed tobject $obiectul = Tobject::get('LaboratoryObservationCode'); $val = $obiectul->get_value(); return $val; Get the needed value

28 3.3 Patient data used Data Type Values Units Glicemia mg/dl Alkaline Reserve 6 26 mmol/l ph Sodium mmol/l Potassium 2 7 mmol/l weight Kg Urea mg/dl Ketones 1 / 0 Boolean

29 3.3 Results * The system was tested for these 30 patients data sets offering the expected recommendations. Recommendation: Administrate 1000 ml NaCl Concentration 0.9 %, 8 units nsulin Patient data

30 Conclusions A method was developed to make medical recommendations more: =>Complex =>Accurate by allowing access to more complex data and increasing CDS interoperability connection of any vmr compatible CDS systems CDS connection with various types of data sources - Advantages resulted using these tools: ü increase in quality of medical care ü providing more efficient treatments ü using new medical knowledge in current clinical practice

31 Thank You for Your attention! This work was partially supported by the strategic grant POSDRU/88/1.5/S/50783, Project ID50783 (2009), co-financed by the European Social Fund Investing in People, within the Sectorial Operational Programme Human Resources Development

Clinical Decision Support

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