clinical decision support as a service - red hat · 2019. 10. 4. · machine learning knowledge...

Clinical Decision Support as a ServiceA cloud native solution Denis GagnéCEO and CTO - Trisotech

Edson TirelliDevelopment Manager - Red Hat May 9th, 2019

What we will be talking about today

● Decision Model and Notation (DMN)

● Clinical Decision Support as a Service

● Demo

* A CDS enabler

* A solution for CDS

* The cool bits

Decision Model and Notation (DMN) Primer

Decision Model and Notation (DMN)● An OMG standard for Decision

Management○ discovery, documentation,

automation○ first published in 2015,

mature implementations available

● Complementary to BPMN (processes) and CMMN (case management)

* Decision

Requirements

Diagram

Decision Model and Notation (DMN)

● Decision Requirements Diagram○ High-level graphical language

● Decision Logic○ Easy-to-learn expression

language: FEEL○ As easy as writing formulas in

Excel

* Decision Table

Leverages AI/ML

● Complements AI / ML / Analytics solutions○ Explainable, white-box decisions

Documentsdata

imagesPredictive

Model

DecisionModel(DMN)

BusinessData

Business Actions

MachineLearning

Knowledge Discovery / Machine Learning

Decision Autom

ation

A common language

● Bridges the communication gap between business and IT○ Out of the box, decision documentation and specification

● Fully executable model, no translations

TechnicalTeam

BusinessTeam

Shared Understanding(model)

From Model to Production

● Improves agility, reduces time to market

● Increases transparency, empowers business

● Natural fit for Cloud based services○ Horizontal scalability○ Out-of-the-box Openshift support

Model

Test

Deploy

Analyze

DMN Motivation

● Own the IP: decision models belong to the company, not tied to product● Cost reduction

○ Availability of documentation, books, training○ Availability of trained professionals○ Availability of tools from multiple vendors

Trisotech and Red Hat● 100% compatibility with the specification● 100% compatibility between tools● Been in production for 2 years● Members of the OMG Review Task Force, driving DMN evolution● Founding members of DMN TCK

Business-Friendly Modeling

Robust Business Automation

DMN and DRL

DMNStandard CompliantHigher level, decision orientedDocument orientedGraphical languageBuilt-in, decision services capabilitiesStateless services

DRLDrools Rule LanguageLower level, rules orientedCode orientedTextual languageAdd-on, decision services capabilitiesStateless and Stateful Services

Busi

ness

Technical* Complementary: use th

e

right tool for the right j

ob

Clinical Decision Support as a Service(CDSaaS)

Hybrid Cloud Solution

Public Cloud

On Premise

Private Cloud

APIAPIAPI API

API

API API

API

API

API

API

API

API

API

API

API

API

API

CDS as a ServicePlatform

DMN

Clinical Decision Support as a Service

All logos, trademarks and registered trademarks are the property of their respective owners.

{…}

API

eHRs or eMRs

Any Apps

API

The DMN Platform Revolution

Explainable AI Inside

CDS as a ServicePlatform • One click UX

• Re-use by reference or by copy• Validation and Testing• Complete Governance of both

Design time and Execution time• Decision Services that can be orchestrated

by any apps

Full lifecycle management platform of Clinical Decision Support Service APIs for composite apps

Decision Automation based on DMN

What you model is what you execute!

Decisions as first class citizen

Visual representation of decisions

Completely explainable decision automation

FHIR• The basic building block in FHIR

is a Resource

• All exchangeable content is defined as a resource

• Resources all share the following set of characteristics:

• A common way to define and represent them, building them from data types that define common reusable patterns of elements

• A common set of metadata• A human readable part

Automate healthcare data sharing and improve patient care

www.hl7.org/fhir/


CDS Hook

• A vendor agnostic remote decision support specification

• Created by the team behind SMART

CDS Service

• A service that is invoked by the EHR via a Hook, evaluates its own logic using FHIR data and returns decision support via Cards

www.cds-hooks.orgAll logos, trademarks and registered trademarks are the property of their respective owners.



SMECreates

CDS Logic Subscriber

Discover


CreatesHook

{…}

** Library of all

available services

USA Pregnancy Context

Maternal Mortality 2x up over last 20 years

01Many other US metrics at third world levels

02Delivery of preventive services less than 40%

03Only 40% of pregnant women get a flu shot

04Only 7% (in Louisiana) get 17-OHP

05

We are failing in basics!

So how do we get guidance to the Point of Care?

Thyroid Disease in Pregnancy Guideline Example

Hypothyroid Pregnancy:Adjust Synthroid Dose Decision

** Unambiguous Guidelines

Hypothyroid Pregnancy:Sharable Clinical Pathway Model

** Knowledge

at point of care

** Context for

informed decisions

A single visual Knowledge Artefact

is created for clinicians and for automation

• The model is the specification• The model is the logic• The model is the documentation• The model is the code

** A single visual

Knowledge Artefact for

clinicians and for

automation

BPM+ Health CommunityForming a robust and thriving community-of-practice of healthcare institutions, professional societies, and vendors

Established to foster the sharing and promulgation of best-practices around modeling and sharing:

• clinical pathways, • clinical guidelines, and • other healthcare knowledge

New!

OMG BPM+ Health Work Group

Goals:Exploring a Model Driven approach to capturing Clinical PathwayUse OMG open standards BPMN, CMMN, and DMN to define the workflow of care and decision-making at the level of granularity that offers a complete, flexible solution, including semantic clarity, robust decision logic, human readable AND machine executable.

Deliverables:Field Guide to Shareable Clinical PathwaysPilot use case: Antenatal Care Models

www.OMG.org

** Where it all

started