medexter - HL7 Austria – HL7 Anwendergruppe Österreich – ?·  · 2017-06-09medexter ® Arden Syntax,…

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  • medexter

    HL7-Standards zur klinischen Entscheidungsuntersttzung

    Klaus-Peter Adlassnig

    Institut fr Medizinische Experten- und Wissensbasierte Systeme Zentrum fr Medizinische Statistik, Informatik und Intelligente Systeme Medizinische Universitt Wien Spitalgasse 23 A-1090 Wien

    und

    Medexter Healthcare GmbH Borschkegasse 7/5 A-1090 Wien

    HL7-Anwendergruppe sterreich, Jahrestagung, 21. Mrz 2012, Wien

    Knowledge packages for integration in:

    - HIS

    - Outpatient IS

    - PDMS

    - LIS

    - Lab analyzer

    - Physicians office

    - Telemedicine

    applications

    - Health portal

    Clinical decision support systems

    Stand-alone solutions:

    - Infection control

    systems

    - Lab decision

    support systems

    - Internal medicine

    decision support

    systems

    - Diagnostic &

    therapeutic

    reminder systems

    Rule engines:

    - Arden Syntax Compiler

    & Engine & IDE &

    Server & host

    interface

    - Fuzzy Arden Syntax

    Compiler & Engine &

    IDE & Server &

    host interfaces

    Services:

    - Rule engine

    integration

    - SOAP & REST & XML &

    HL7 interoperability

    - Medical

    documentation &

    ontology services

    - Fuzzy-based medical

    text formalization

    Medical Content

    Medical knowledge packages

    Inference systemsMedical consulting

    services

    Technical Frameworks Medical Services

    Medexter Healthcare

    Teleiatros services:

    - Browser-based or

    direct server access

    to decision support

    systems

    - Writing and tele-

    operating customer-

    specific Arden Syntax

    & Fuzzy Arden

    Syntax MLMs

    Telemedicaldecision support

    services

  • medexter

    Computers in clinical medicinesteps of natural progression

    step 1: patient administration

    admission, transfer, discharge, and billing of medical services

    step 2: documentation and access of patients structured medical data

    electronic health record: distributed, life-long

    step 3: patient data retrieval and analysis

    data warehouse, research databases, study support systems, quality assurance and reporting

    for a group of patients

    step 4: software systems for clinical decision support

    safety net, quality assurance and improvement

    for the individual patient

  • symptoms signs

    test results clinical findings

    biosignals images

    diagnoses therapies

    nursing data

    standardization telecommunication

    chip cards

    anatomy biochemistry physiology

    pathophysiology pathology nosology

    therapeutic knowledge disease management

    subjective experience intuition

    knowledge-based systems

    patients medical data physicians medical knowledge

    medical statistics clustering & classification data & knowledge mining

    machine learning

    clinical decision support medical expert systems

    many patients

    single patient

    diagnosis therapy

    prognosis management

    general knowledge

    general knowledge

    telemedicine telemedicine integration

    Medical information and knowledge-based systems

    information systems

    induction

    deduction

  • medexter

    Clinical decision support systems

    patients structured medical data

    patient management guidelines

    guideline-based reminders

    computerized clinical guidelines, protocols, SOPs

    high-level patient and hospital analytics

    prognostic prediction

    illness severity scores, prediction rules

    trend detection and visualization

    therapy advice

    drug alerts, reminders, calculations

    indication, contraindications, redundant medications, substitutions

    adverse drug events, interactions, dosage calculations, consequent orders

    management of antibiotics therapy

    (open-loop) control systems

    diagnostic support

    clinical alerts, reminders, calculations

    data interpretation, (tele)monitoring

    differential diagnostic consultation

    rare diseases, rare syndromes

    further or redundant investigations

    pathological signs accounted for

    consensus-criteria-based evaluation

    definitions

    classification criteria

  • medexter

    Arden Syntaxmedical knowledge representation and

    processing

  • medexter

    Arden Syntax and Health Level Seven (HL7)

    A standard language for writing situation-action rules that can trigger alerts based on abnormal clinical events detected by a clinical information system.

    van Bemmel, J.H., Musen, M.A. (eds.) (1997) Handbook of Medical Informatics, Springer-Verlag, Heidelberg, Glossary, p. 559.

    Each module, referred to as a Medical Logic Module (MLM), contains sufficient knowledge to make a single decision.

    extended by packages of MLMs for complex clinical decision support

    Contraindication alerts, management suggestions, data interpretations, treatment protocols, and diagnosis scores are examples of the health knowledge that can be represented using MLMs.

    extended by single and differential diagnostic support, temporal monitoring, control systems, computerized processing of clinical pathways and management guidelines

    The first version of the Arden Syntax (draft prepared at the Arden Homestead, New York, in 1989) was administered and issued by the American Society for Testing and Materials ASTM (1992, version 1.0; today 2.8, towards 2.9). Ownership was transferred to HL7 and the American National Standards Institute (ANSI) in 1999 with the approval of version 2.0.

  • medexter

    General MLM Layout

    Maintenance Category Library Category Knowledge Category Resources Category

    Identify an MLM Data Types Operators

    Basic Operators Curly Braces List Operators Logical Operators Comparison Operators String Operators Arithmetic Operators Other Operators

    Control Statements Call/Write Statements and Trigger

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    Arden-Syntax-based, service-oriented

    clinical decision support

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    Arden Syntax, Arden Syntax server, and health care information systems

    Funktionalitt

    Integration

    KIS, MIS, PDMS, LIS, Praxissoftware, EHR, telemedizinische Anwendungen, Gesundheitsportale,

    Reminder und Alarme, Monitoring, Surveillance, Entscheidungsuntersttzung fr Diagnostik und Therapiewahl,

    operativ: - Harmonisierung der Inputdaten - Arden-Syntax-MLMs - Erklrungskomponente

    erforschend: - Regellernen und -tuning - Daten- und Konzeptmining

    * Daten- und Wissensbasen-Zentrum

  • medexter

    web-services-based Arden Syntax server including

    - Arden Syntax engine - MLM manager - XML-protocol-based interfaces, e.g., SOAP, REST, and HL7 - a project-specific data and knowledge services center may be hosted

    Java libraries - Arden Syntax compiler - Arden Syntax engine

    Arden Syntax server and software components

    Arden Syntax development & test

    environment

    data & knowledge services center

    Arden Syntax rule engine

    knowledge

    knowledge

    results

    data

    healt

    h c

    are

    in

    form

    ati

    on

    syste

    m

    results

    reporting tools

    knowledge administration

    data

    inte

    rfaces

    2)

    Arden Syntax server 1)

    1) integrated, local, or remote2) local and web services, web frontend

    Arden Syntax development & test

    environment

    data & knowledge services center

    Arden Syntax rule engine

    knowledge

    knowledge

    results

    data

    healt

    h c

    are

    in

    form

    ati

    on

    syste

    m

    results

    reporting tools

    knowledge administration

    data

    inte

    rfaces

    2)

    Arden Syntax server 1)

    1) integrated, local, or remote2) local and web services, web frontend

    Fuzzy Arden Syntax

    extension to fuzzy sets, operators, statements, and parallel execution

    Arden Syntax integrated development and test environment (IDE) including

    - Medical logic module (MLM) editor and authoring tool - Arden Syntax compiler (syntax versions 2.1, 2.5, 2.6, 2.7, and 2.8) - Arden Syntax engine - MLM test environment - MLM export component

    command-line Arden Syntax compiler

  • medexter

    Crisp sets vs. fuzzy sets

    yes/no decision

    gradual transition

    age

    1

    Y young

    0 threshold

    U = [0, 120]

    Y U with Y = {(Y (x)/ x)x U}

    Y: U [0, 1]

    1

    1 + (0.04 x)2 x U 0 age

    1

    Y young

    threshold 0

    U = [0, 120]

    Y U with Y = {(Y (x)/ x)x U}

    Y: U {0, 1}

    Y (x) = x U 0 x > threshold 1 x threshold

    1 x threshold

    x > threshold Y (x) =

    0

  • medexter

    Interoperability

  • Monitoring of

    healthcare-associated infections

  • Interpretation von

    Hepatitis-Serologie-Befunden (I)

  • Interpretation of

    hepatitis serology test results (II)

  • Integration into

    i.s.h.med

  • medexter

    GELLO/vMRQuery and