Health Knowledge Management for Clinical Decision Support Services

Health Knowledge Management for Clinical Decision Support Services: Art of the Possible Raza Abidi Professor of Computer Science Director of Health Informatics Faculty of Computer Science Dalhousie University Halifax, Canada sraza@cs. dal. ca www. cs. dal. ca/~sraza

Agenda Healthcare Knowledge Management v v From Health Data to Healthcare Knowledge Healthcare Services v v Clinical Decision Support as a Service Healthcare Knowledge Modeling v v 2 Towards a Healthcare Enterprise © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Preamble trying harder to make the existing system work better will not be enough (Institute of Medicine) Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000. 3 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Healthcare IT …. State of Practice v Data- and information driven v v Support for individual healthcare tasks v v v Patient activates the process …. Healthcare team responds Healthcare (proactive and personalized) planning? Quasi-deterministic action paths v v 4 Self contained (localized) Information Infra-structures Healthcare enterprise? Re-active v v Process level data capture and use Healthcare services? Islands of automation v v Health Databases Healthcare Information Management Systems Healthcare knowledge? Built on localized information flows and clinical practices Healthcare standardization? © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

From Health Data to Healthcare Knowledge Practitioner’s Knowledge Healthcare Knowledge Management Best Evidence Policies Standards Processes Electronic Health Records Patient Clinical Management Decision Support Laboratory Pharmacy Data Health Patient Care Promotion Planning Radiology Finance 5 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza) (CPOE) Optimization HEALTH KNOWLEDGE INFORMATION MANAGEMENT SYSTEM Best Evidence Patient (Info-Buttons) Data Registration Physician Orders Clinical Information Management Pathways Picture Data Knowledge Archiving Outcome Generation & & Comm. Measurement System Translation (PACS) Resource Patient Scheduling Empowerment Administration Inventory

Healthcare Knowledge Management “Healthcare Knowledge Management can be characterized as the systematic creation, modeling, sharing, operationalization and translation of healthcare knowledge to improve the quality of patient care” (Abidi, 2008) SSR ABIDI. Healthcare Knowledge Management: The Art of the Possible. In David Riano (Eds) K 4 CARE, Lecture Notes in Artificial Intelligence LNAI 4924, Springer, 2008, pp. 1 -21. 6 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Operationalization Computerization © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza) Modeling Healthcare Knowledge Healthcare Data E-Health Social Networks Patient Empowerment Info-Buttons Care Standardization & Audit Care Management & Planning Risk Assessment Healthcare Services Evaluation Tools Medical Literature Nursing Care Plans Workflow Integration Clinical Pathways/Protocols Clinical Practice Guidelines Evaluation Clinical Decision Support Delivery Practitioner’s Know How Safe, Quality, Cost-Effective, Pro-active and Planned Patient Care Healthcare Enterprise

Healthcare Knowledge Centric Services Transformational Knowledge Translation Services Public Health Patient Care Services Patient Management Knowledge Sharing Knowledge Access Enabling Services Automated Outcome Analysis Personalized Patient Education & Empowerment Clinical Decision Support Info-Buttons Patient Monitoring Patient Care Planning Knowledge Sharing (Community of Practice) Patient Safety Alerts & Reminders Computerizing Healthcare Knowledge (CPG, Clinical Pathways, Care Plans) © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza) Care Team Collaboration Knowledge Annotation & Indexing Healthcare Knowledge Indexing & Storage Healthcare Knowledge Procurement Risk Assessment Social Networking Analysis Best Evidence Retrieval Policy Development Public Health Interventions Public Health Surveillance Bio-medical Terminologies Knowledge Creation 8 Technology-Enabled Knowledge Translation Semantic Interoperability Healthcare Text Analysis (Mining) Healthcare Knowledge Modeling & Representation Healthcare Knowledge-Centric Services HKM Service Types

FOCUS: Clinical Decision Support Services 9 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Clinical Decision Support Lifecycle • Interpretation of domain concepts • Identification of Processes, Actions, Decisions, Recommendations, Constraints, etc. • Specification of decision making algorithm • Clinical Pragmatics es ic ec o isi D n t or pp Su Procurement Evaluation Workflow Integration • Point-of-care access • Integration with infra-structure v er S Healthcare Knowledge KM Operationalization • System Execution • Input: Patient data • Output: Patient-specific knowledge Modeling Storage Inferencing/Rea soning 10 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza) Codification • Decision Model • Arden syntax • Ontology • Logical rules • Knowledge base • Reasoning engines • Selection and manipulation of knowledge

Towards CDSS Institutional considerations Text-based CPG representation formalism & CPG encoding strategy Localized CPG Computerized CPG Clinical workflow, pragmatics & reasoning strategy Clinical Decision Support System CPG-based, Patient-Specific Recommendations 11 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza) Patient Data

Healthcare Knowledge Modeling Introduction Section B Plan X Process P Action CPG Sync Action Data Process R Plan Y Section C 12 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza) Action Decision False Action Decision Recommendation A Recommendation B True Action True Tasks False Recommendation C

Knowledge Model Clinical Management of Chronic Hepatitis B 13 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Diagnosis and Treatment of Acute Otitis Media (AOM) in Children 14 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Computerization of Clinical Pathways (CP) v Knowledge Modeling v v Modeling CP knowledge as an ontological model ‘Unified’ model of the CP v v Modeling the ‘branching’ and ‘merging’ points to align multiple CP v v Turning localized CP to a generic model Common processes, actions and recommendations Knowledge Execution v Execution of prostate cancer CP using a logic-based reasoning engine © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Prostate Cancer Management System 16 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

Prostate Cancer Management System 17 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

CPG Based Decision Support System SYSTEM DEMO © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

CPG Driven Decision Support System SYSTEM DEMO © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)

THANK YOU Raza Abidi sraza@cs. dal. ca www. cs. dal. ca/~sraza @ NICHE Research Group (k. Nowledge Intensive Computing for Healthcare Enterprises) www. cs. dal. ca/~niche 20 © Dr. Syed Sibte Raza Abidi, (www. cs. dal. ca/~sraza)