ppads: physician- parent decision-support for nicu

Frize Bariciak Gilchrist Medinfo 2013

PPADS: Physician-PArent Decision-Support for NICU

Dr. Monique Frize, O.C., P. Eng., FIEEESystems and Computer Engineering (SCE) , Carleton University

Erika Bariciak, MDChildren’s Hospital of Eastern Ontario (CHEO)

Jeff Gilchrist, PhDAdjunct professor, SCE, Carleton University


Content

• Objectives (CDR, ANN, PPADS)

• Methodology

• Results

• Conclusion and Future Work


Objectives• Collect data from NICU patients in real-time

and store in Clinical Data Repository• Adapt our outcome estimation system to

processing real-time data• Develop PPADS: A decision-support module

for physicians and a module for parents.


Clinical Data Repository Design

• Database uses open source MySQL and Entity-Attribute-Value format + time (EAVT).

• Confidential information separated from data for research.

• Study ID is used to associate patient ID with research data in an anonymous way


Clinical Data Repository

Hospital Network

ADTSystem

HL7HL7

HL7

Clinical DataRepositoryHL7

MIRTH

MySQL Database

PrivatePatient

Data

De-IdentifiedMedical Data

Lab SystemPatient Monitors


Outcome estimations

• Decision Trees and Artificial Neural Network

• Estimating Mortality

• Using real time data and summary data.


Methodology

• 1. Evaluation of CDR: storage, speed, complexityand pilot survey at hospital (MeMeA 2013)

• 2. Outcome estimationsCollected 85 million data points from 634 infants in NICU 2010 and 2011Admission (12 hrs), 24 hrs, 48 hrs5x2 cross validation approach Pre-processing and ANN analysis

• 3. Developed PPADS: Physician module and Parent module


Results--CDR

• CDR was better performing than the single EAV and the Multi-data type in terms of storage space, speed and complexity of query.

• Pilot test at CHEO with over 75 researchers and physicians: very positive results.


Results– Outcome estimation

• Best results were obtained with data collected at 48 hours after admission.

• Mortality estimations: Specificity of 99 %; sensitivity of 63%;

PPV of 73%; and NPV of 98%... which meet our clinician’s expectations.


Results-- PADS

PPADS: Identified criteria and mode of operation Examined standards, applied IPDAS Usability 8 parents and 5 neonatologists with very positive results.


PPADS: Physician-Parent Decision Support


Physician Module Summary Page


Parent Module

• Patient management decision – Families bear: Emotional consequences

Financial consequences

• Collaborative care decisions


Parent Account

• Home Page • Current condition • Current treatments • Outcome predictions • Decision support aid • Glossary


Home Page Parents


Outcome Estimation Example


Decision-Support Process


Conclusion and Future Work• CDR design de-identifies data automatically, uses opens-source tools

and easy to collect, store, and retrieve data.

• ANN performs better than Decision Trees; expanding to predict other outcomes (Length of stay, duration ventilation, IVH, BPD, NEC, ROP) with alerts.

– Future work: add input variables to improve performance.– Add warnings and alerts and perform usability study.

• PPADS well received by physicians and parents– Next phase: parents of infant who died; then randomised clinical trial with

parents of babies in NICU– More types of decisions will be added.


Contact Information

• Monique Frize, P. Eng., O.C., FIEEE• Distinguished Professor, Carleton University• Systems and Computer Engineering• Ottawa Ontario Canada

• Email: [email protected]

ppads: physician- parent decision-support for nicu

Documents

monique frize

summary data

research data

objectivescollect data

data points

decisionsupport module

clinical data repositoryadapt

real time data