Transcript No Slide Title

CLINICAL DECISION SUPPORT
AND PROGRAMMING IN ARDEN
SYNTAX
DR ANTHONY MADDEN
Consultant Anaesthetist
& ACIS Programme Director
North Bristol NHS Trust
AIMS
• to explain the term ‘Clinical Decision Support'
in the context of EPR/EHR
• to explain why we need CDS
• to explain what Arden Syntax is
• to introduce programming medical logic
modules in Arden Syntax
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden
Syntax
CLINICAL DECISION SUPPORT
“Pull Technology”
• Medline
• Embase
• NELH
• Internet
• WeBNF
CLINICAL DECISION SUPPORT
“Push Technology”
• Notes
• Order sets
• Care pathways
• Expert systems
• Arden Syntax
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden
Syntax
CLINICIANS NEED INFORMATION
AT THE POINT OF CARE
“If we managed travel like we manage
healthcare then travel agents would
book flights on the basis of the flight
schedules they could remember"
Lawrence L Weed
HOSPITAL FATALITY RATE
“In the USA medical error results in
44,000-98,000 unnecessary deaths
each year and 1,000,000 excess
injuries”
Epidemiology of medical error
BMJ 18 March 2000
EFFECTIVENESS OF CDSS
Perioperative Antibiotic Administration
• Intervention : reminder re timing and type
of antibiotic
• Period : 1988 - 1994
• Result : perioperative wound infections
declined from 1.8% to 0.9%
• average # doses : 19 to 5.3
• antibiotic cost per patient: $123 to $52
(Pestotnik, LDS Hospital: Ann Intern Med 1996;124(10):884-90)
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden
Syntax
MEDICAL LOGIC MODULE
•
Each MLM contains maintenance
information, links to other sources of
knowledge, and enough logic to make a
single health decision
•
The Medical Logic Module (MLM) is a
stream of text stored in an ASCII file in
statements called slots
ARDEN SYNTAX - DEFINITION


Arden Syntax is an HL7/ANSI
standard specification for defining
and sharing medical logic. It is a
programming language.
Current approved version is 2.1
ARDEN SYNTAX - HISTORY
HELP
LDS Hospital
Salt Lake City,
UT
CARE
Regenstrief Institute
Indianapolis, IN
Arden Syntax
Retreat at Arden Homestead, Harriman, NY 1989
Arden Syntax
• Version 1: 1992
• Version 2: 1999
• Version 2.1 : 2002
ASTM document 1460
HL7/ANSI
HL7/ANSI
SUPPORT FOR ARDEN SYNTAX
• Eclipsys / iSoft
• IBM
• McKessonHBOC
• SMS
• Siemens
• Epic Systems
• Cerner
• Micromedex
Arden: New Initiatives
• Structured Write statement:
- XML DTD
• Representing MLMs in XML
• Data Model: Fuzzy logic, standard
expression language, etc
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden
Syntax
MLM - Structure
Categories & Slots
maintenance:
slotname: slot-body;;
library:
slotname: slot-body;;
knowledge:
slotname: slot-body;;
end:
Maintenance Category Slots (9)
• Title
• Mlmname
(formerly called filename)
• Arden
• Version
• Institution
• Author
• Specialist
• Date
• Validation
Library Category Slots (5)
•
•
•
•
•
Purpose
Explanation
Keywords
Citations (optional)
Links (optional)
Knowledge Category Slots
(7)
• Type
• Data*
• Priority
• Evoke
• Logic*
• Action
• Urgency
Data Slot
• Terms
in the medical logic module
must be mapped to a database
• Use
of curly braces { } allows
flexibility in mapping to the
institution’s local database
• Mapping
terms in this way separates
the logic in the MLM from institutionspecific information
Logic Slot
•
Logical algorithm
‘If…….then…..’
•
Ends with a “conclude statement”
conclude true;
or
conclude false;
Conclude Statement
•
conclude true;
terminates the rule
go to the action slot
•
conclude false;
terminates the rule
do not go to the action slot
go to end;;
PLAYTIME!