Project Sponsor: HL7 Clinical Decision Support (CDS)

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Gabriel Andrews
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1 Project Sponsor: HL7 Clinical Decision Support (CDS) Technical Lead: Robert Dunlop, MD Director, Product Development InferMed UK (M)

2 Create an HL7 vmr data model recommendation and implementation guide, based on the HL7 v. 3 RIM, which is capable of supporting clinical decision support for Chronic Disease Management at the point of care. ~ Utilize existing HL7 data models as the basis for developing the vmr recommendation. ~ Develop vmr concept capable of supporting CDS Computer-Interpretable Guidelines. 2

3 vmr Alignment Diagram OMG Base Storyboards Point of Care Interacting with Product Vendor Systems Aligned to HL7 Data Models Interoperable with HL7 Service Functional Model Interacting with HL7 CDS Guidelines Brain Aneurysm Breast Cancer w/family History Type 2 Diabetes Hypertension Physician At PoC Clinical Information Systems Export Data Via System Interface Capabilities vmr for Chronic Disease Management Inputs & Outputs SOA Web Services Computer- Enabled Clinical Guidelines & Protocols Clinical Assessments, Decisions, Goals, Alerts & Reminders 3

carrying Patient data inputs CDS outputs Implementation data Needs integration of genomic/pedigree data models CareStatement to carry

4 Development of 4 business use cases: Breast cancer Cerebral aneurysm Hypertension Type 2 Diabetes Recommendation to use HL7 Care Record DSTU Message Reviewed BUCs against Care Record Comparative Analysis Results of Analysis Care Record appears suitable for carrying Patient data inputs CDS outputs Implementation data Needs integration of genomic/pedigree data models CareStatement to carry patient data inputs to CDS service CarePlan DefinedCare for recommendation outputs CarePlan DeliveredCare for implementation data 9/08 Ballot 4

5 vmr Business Use Cases* CDS Inputs HL7 Alignment Patient - Identifier X X X X Patient.id Patient - Gender X X X X Patient - Date of Birth X X X X Person.birthTime Patient Height; Weight; Blood Pressure X X X X Patient - Race X X X Person.raceCode Patient Symptoms X X X Patient Diagnoses (past; present) X X X X Patient Allergies Patient Lab Test Results X X X X Patient Genetic Results X X Patient - Radiology Results X X X X Clinical Genomics Genotype Patient Surgical Procedures X X X CareStatement Procedure Patient - Medications X X X X CS SubstanceAdministration Patient - Pregnancy Status X X X Patient Menopausal Status X X X Patient Wish to have additional children X X X Patient Smoking Status X X X Family History of Disease: X X X X Clinical Genomics Pedigree - Relative Id X X X X - Relative Type X X X X - Relative Diagnosis X X X X - Age of Onset X X X X - Age at Death X X X X Clinical Examination Assessment CarePlan: PlannedCare / Observation Description X X ObservationIntent Clinical Examination Assessment / Observation Recommendation X X CarePlan: PlannedCare ObservationIntent Answers to Risk Assessment Questionnaires X X X X CarePlan: PlannedCare ObservationIntent Request for CDS Risk Assessment X CarePlan ProcedureIntent CDS Recommended Action CarePlan: PlannedCare ActIntent Confirmed Or Declined X X X X 5

6 vmr CDS Outputs Business Use Cases* HL7 Alignment Patient - Identifier X X X X Patient.id Risk Assessment Questions & Potential Responses X X X X ObservationDefinition CDS Alerts X X X CarePlan ActDefinition CDS Decision Recommendations**: X X X X CarePlan ActDefinition - Supporting Arguments X X X X To be decided - Argument Pros & Cons X X X X To be decided - Provenance for Arguments X X X To be decided CDS Recommended Actions (Dynamically Generated Order Set) Executable Guideline State Audit File X X X X To be decided X X ActDefinition **Types of CDS Recommendations CDS Differential Diagnosis - Diagnosis Options X X ObservationDefinition - Supporting arguments X To be decided - Provenance for Arguments X To be decided CDS Risk Determination: X X X X - Risk Assessment Score (numeric) X X X - Risk Assessment Options (categoric) X ObservationDefinition ObservationDefinition - Supporting Arguments X X X X To be decided - Provenance for Arguments X X X X To be decided CDS Disease Stage/Classification: - Disease Stage Options X X ObservationDefiniton - Supporting Arguments X To be decided - Provenance for Arguments X To be decided 6

7 vmr CDS Outputs (contd) Business Use Cases* HL7 Alignment **Types of CDS Recommendations CDS Therapeutic Recommendations X X X X - Drug Therapy Options X X X - Non-drug Therapy Options X X X X - Procedures X X X X SubstanceAdmnDefinition ProcedureDefinition - Supporting arguments X X X X To be decided - Provenance for Arguments X X X X To be decided CDS Target/Goals: X X - Target/Goal Options X X ObservationDefinition ObservationGoal - Supporting Arguments X X To be decided - Provenance for Arguments X X To be decided CDS Follow-up Recommendations X X X - Follow-up Options X X X EncounterDefinition - Supporting Arguments X X X To be decided - Provenance for Arguments X X X To be decided CDS Clinical Progress - Clinical Progress Options X X ObservationDefinition - Supporting arguments X To be decided - Provenance for Arguments X To be decided 7

8 The diagram illustrates the CareRecord Class Model Two elements of the CareRecord are relevant to the vmr CareStatement Carries patient data, eg from the CRIM CarePlan Carries CDS recommendations

9 The CareStatement Class Model is expanded below:

10 CareStatement contains several relevant classes Observation Diagnoses; findings; results SubstanceAdministration Prescribing information Procedure Operation; intervention Encounter Act Outpatient visit; admission Other types of actions

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13 Recommendation is that vmr will use DefinedCare for messaging CDS recommendations Currently, DefinedCare model is too limited in scope to handle Use Case examples

14 Initial Hypertension Treatment Options decision from hypertension use case Two decision candidates: Lifestyle modifications Drug therapy Each candidate supported by arguments For example: Blood pressure grade 1. Three or more risk factors present

15 The Decision will be represented by an Act Each Candidate will be a separate Act Candidates will be linked to the parent Act by an ActRelationship

16 Implementation Project 16

17 Review conformance of genomics and pedigree models To be carried within CareStatement Review CDS outputs Revise CarePlan model September

HL7 CDS Project Update

HL7 CDS Project Update Virtual Medical Record (vmr) Clinical Genomics HL7 Phoenix May 2008 Robert Dunlop, MD Technical Lead: HL7 vmr & GELLO Projects InferMed UK Director, Clinical Development (M) +44-7291-7410