Clinical Decision Support (CDS) is a top priority of modern Healthcare organizations. It is perceived as a key enabler for quality of care, improved patient safety and improved patient satisfaction. The advent of cloud native architecture combined to the availability of modern open standards for healthcare and IT provides unprecedented opportunities to create Clinical Decision Support as a Service that can handle complex decision logic with a simple business friendly interface that provides feedback and explanation to the practitioners and care takers. In this session, we explain and demonstrate how Trisotech, using Red Hat Decision Manager, was able to create a Clinical Decision Support as a Service solution based on FHIR, CDS Hook, DMN and Open API. This solution provides Healthcare organizations with the capability to consume CDS services via Open API directly from within their existing EHR or EMR. Healthcare organizations can elect to consume predefined CDS services, to customize existing CDS services to meet their local reality or to create their own CDS services using a simple user-friendly interface amicable to practitioners and care takers. Examples of Healthcare organizations using this solution will be provided during the session.

1. Clinical Decision Support as a Service
A cloud native solution
Denis Gagné
CEO and CTO - Trisotech
Edson Tirelli
Development Manager - Red Hat
May 9th, 2019

2. What we will be talking about today
● Decision Model and Notation (DMN)
● Clinical Decision Support as a Service
● Demo

3. Decision Model and Notation (DMN)
Primer

4. 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)

5. 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

6. Leverages AI/ML
● Complements AI / ML / Analytics solutions
○ Explainable, white-box decisions
Documents
data
images
Predictive
Model
Decision
Model
(DMN)
Business
Data
Business
Actions
Machine
Learning
Knowledge Discovery / Machine Learning
DecisionAutomation

7. A common language
● Bridges the communication gap between business and IT
○ Out of the box, decision documentation and specification
● Fully executable model, no translations
Technical
Team
Business
Team
Shared Understanding
(model)

8. 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

9. 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

10. 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

11. DMN and DRL
DMN
Standard Compliant
Higher level, decision oriented
Document oriented
Graphical language
Built-in, decision services
capabilities
Stateless services
•DRL
Drools Rule Language
Lower level, rules oriented
•Code oriented
•Textual language
•Add-on, decision services
capabilities
•Stateless and Stateful Services
Business
Technical

12. Clinical Decision Support as a Service
(CDSaaS)

13. Hybrid Cloud Solution
Public Cloud
On Premise
Private Cloud
APIAPI
API API
API
API API
API
API
API
API
API
API
API
API
API
API
API

14. CDS as a Service
Platform
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

15. The DMN Platform Revolution
Explainable AI
Inside
CDS as a Service
Platform • 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

16. 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

17. 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/
All logos, trademarks and registered trademarks are the property of their respective owners.

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

19. Business-Friendly Modeling
Robust Business Automation
SME
Creates
CDS Logic
Subscriber
Discover
All logos, trademarks and registered trademarks are the property of their respective owners.
Creates
Hook
{…}

20. USA Pregnancy Context
Maternal
Mortality 2x up
over last 20
years
01
Many other US
metrics at third
world levels
02
Delivery of
preventive
services less
than 40%
03
Only 40% of
pregnant women
get a flu shot
04
Only 7% (in
Louisiana) get
17-OHP
05
We are failing in basics!
So how do we get guidance to the Point of Care?

21. Thyroid Disease in
Pregnancy
Guideline Example

22. Hypothyroid Pregnancy:
Adjust Synthroid Dose Decision

23. Hypothyroid Pregnancy:
Sharable Clinical Pathway Model

24. 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

25. BPM+ Health Community
Forming 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

26. OMG BPM+ Health
Work Group
Goals:
Exploring a Model Driven approach to capturing Clinical
Pathway
Use 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 Pathways
Pilot use case: Antenatal Care Models
www.OMG.org

27. Business-Friendly Modeling
Robust Business Automation