CLINICAL DECISION SUPPORT WITH DECISION MODEL AND NOTATION (DMN)

Presenter: Vipul Kashyap, Matteo Mortari Presenter’s title: Director, Clinical Information Systems, Date: May 8th, 2018 *Special Thanks to Denis Gagne, Simon Ringuette from Trisotech for DMN Authoring support

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Outline

● Clinical Decision Support (CDS) and LACE Score

● CDS Lifecycle

● Clinical Informaticist (CI)/Business Analyst (BA) Friendly

● Decision Modeling Notation

● Demo

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. https://www.healthit.gov/topic/safety/clinical-decision-support

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

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

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

Decision Model and Notation Decision Requirements Diagram (DRD)

Input Node Decision Node

Business

Knowledge Model

DMN examples of boxed expressions and FEEL examples

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

Rules Authoring: Current State

Rules Authoring: Current State

Separate Project File for Charleson Score

Need to download Spreadsheet for understanding Logic!

Input

Decision

Sub-Decision

Business

Knowledge

Model

Decision Content

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

Test and Refine Model

Specify Test Data

Current Encounter

with Length of Stay = 6 Days

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

All related sub All related sub-decisions are also retrieved

are also retrieved!

Reusable Encapsulated

Service

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

Decision Content

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

Content of a “Content Decision Node”

used in Decision Logic

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

Reusable

Function

Decision Node

Invoking that function

Invokes

CDS Lifecycle

CDS Logic

Requirements

Reuse:

Enterprise Data Model for

Logic Data Elements

Search/Reuse:

Pre-existing Decisions,

Decision Services

Search/Reuse:

Pre-curated Concept Sets

(e.g., Diabetes)

Search/Reuse:

Parameterized Functions

Author DMN Model Refine and Test DMN

Model

Publish DMN Model/

Specify Metadata for

Cataloging

Deploy Model for

Execution + Operational

Auditing

Operational Evaluation of

Model – (False Positives,

Negatives)

Model

Payload

Model Auditing

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

Acknowledgments ● Vish Anantraman

● Harikrishna Nandigam

● Amitabh Nayak

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