Pharmacy OneSource_Drools in Healthcare Bootcamp Oct 2011

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Pharmacy OneSource_Drools in Healthcare Bootcamp Oct 2011

  1. 1. Speed Saves LivesLeveraging a Massively Parallel Expert System for Patient Surveillance 1
  2. 2. Pharmacy OneSource•9 SAAS healthcare applications•1 in 3 hospitals in the U.S. utilize our applications•Active community of > 44,000 of pharmacy professionals. 2
  3. 3. Sentri7 Clinical WorkflowsSurveillanceInterventionDocumentationReporting 3
  4. 4. What do we mean by…Surveillance: Actively monitoring patients to identifyopportunities for interventionIntervention: changing patient care to improve outcomesOutcomes: Quality & Safety Efficacy Efficiency Cost effectiveness 4
  5. 5. Electronic Medical Records EMR Medications Surgeries Visit Diagnoses Observations Vitals Patient Clinician Lab technician 5
  6. 6. Enhancing the EMR •Activating data ClinicianEMR •Intelligent Decisions 6
  7. 7. Reasoning in real timeOn DemandEvent Driven 7
  8. 8. Event Stream Processing Rule Rule Rule Rule Rule T-1 Rule U-1 Rule CE-1 Rule S-1 T-2 U-2 CE-2 S-2 Rule Rule Rule Rule T-N U-N CE-N S-N 8
  9. 9. Extract meaning with rulesHL7 standard open to interpretation •Discrete and non-discrete data elements •Variance between vendors & systems •IDNs, Sites, and departmentsUnderstanding the clinical meaning of a message •Patient admission & discharge •Active/visible medications •Estimated creatinine clearance •MDRO classification 9
  10. 10. What does it mean? MSH|^~&|EPIC|EPICADT|SMS|SMSADT|199912271408|CHARRIS|ADT^A04|1817457|D|2.5| PID||0493575^^^2^ID 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^|19480203|M||B|254 MYSTREETData AVE^^MYTOWN^OH^44123^USA||(216)123-4567|||M|NON|400003403~1129086| NK1||ROE^MARIE^^^^|SPO||(216)123-4567||EC||||||||||||||||||||||||||| PV1||O|168 ~219~C~PMA^^^^^^^^^||||277^ALLEN MYLASTNAME^BONNIE^^^^|||||||||| ||2688684|||||||||||||||||||||||||199912271408||||||002376853Facts 10
  11. 11. Determine relevance with rules•Clinical outcomes & risk define time windows•Active alerting•Daily/weekly routines•Criteria may exclude portions of the patient model orpatient populations•Admission/discharge•Location, patient status. 11
  12. 12. Event Lifespan Reported AnalyzedObserved Received Archived Event Relevance Window 12
  13. 13. Patient surveillance with rules Active drug order for "Piperacillin" Estimated Last Creatinine Estimated Clearance < 40 Creatinine ml/min in the Clearance > 40 last 10 days ml/min 13
  14. 14. Sentri7 surveillance rule builder 14
  15. 15. Iterative refinement in computer systems Any automated system has this cycle Agile attempts to reduce cycle time 15
  16. 16. Rule engine performance FxR=P Facts X Rules = Evaluations1 Patient 550 X 57 = 31,4281 Hospital 605,000 X 57 = 34,571,428350 Hospitals 211,750,000 X 20,000 = 4,235,000,000,000 16
  17. 17. How does reasoning time affect patient care?•Perception ofresponsiveness•Time sensitivityof outcomes 17
  18. 18. Perception of responsiveness1. Speed is everything—this is what information system users value most.2. Anticipate needs and deliver in real time—deliver information when needed.-“Ten Commandments for Effective Clinical Decision Support” American Medical InformaticsAssociation, 2003 18
  19. 19. Time sensitivity of outcomesSimple, low risk. Therapeutic substitution.“Nexium IV substituted to protonix”Show all patients that have an active drug order where the drugname contains the phrase "Pantoprazole Sodium" and route is IVComplex, high risk. Sepsis.“At Very high risk for Severe Sepsis with shock”. 19
  20. 20. At very high risk for severe sepsis with shockShow all patients that have at Group Cleast one match from each of the -Lactic Acid >= 3.5 mmol/Lfollowing groups in the last 24 -Serum Creatinine > 2 mg/dLhours. -Estimated Creatinine Clearance < 50 ml/min -Platelet count < 80 thou/uLGroup A -Active Drug Order where Drug Name is not in the list ("WARFARIN SODIUM", "ENOXAPARIN -Pulse > 90 SODIUM", "HEPARIN SODIUM, PORCINE") AND has one of the following: -Resp < 20 -PT (INR) > 1.5 -aPTT > 60 sec -PaCO2 < 32 mmHg -BILIRUBIN TOTAL > 2 mg/dL AND ALT (SGPT) >114 U/L -Temp not in the range -VENOUS O2 SATURATION (VO2HB) < 70%96.8 F to 100.4 F -pH < 7.30 -PaO2 < 80 mmHgGroup B -pH < 7.35 AND PaCO2 < 50 mmHg -WBC Count not in the Group Drange 4 thou/uL to 12 thou/uL -SYSTOLIC BP < 90 -Band > 10 % -SYSTOLIC BP has decreased 28% 20
  21. 21. Impact of Sepsis on Patient Health • > 200,000 deaths per year in the US Patient Lives • Mortality from severe sepsis is between 28-50% (with standard care) • $16.7 billion in total annual U.S.Hospital costs Costs • Average cost = $22,100 - $29,900 • Average LOS = 19.6 - 23.3 days Angus DC et al. Crit Care Med 2001;29(7):1303-1310. 21
  22. 22. Space-Based Architecture 22
  23. 23. GigaSpaces XAP – Elastic Application Platform DATA PROCESSING EVENTS & MESSAGING WEB APPLICATION SUPPORT MANAGEMENT & HIGH AVAILABILITY ELASTICITY CLOUD MONITORING READINESS 23
  24. 24. GigaSpaces + DroolsPerformance  Collocate rules with the data allowing extreme low latency rules executionRules Management  Dynamically load/unload rules leveraging GigaSpaces & Drools APIsUltra Scalable  Parallel rules execution across the different data-grid partitionsElasticity  Scale- up/down, in/out system and leverage extra resources on-demand within private cloud or public cloud.High-Availability  Continuous availability running rules 24X7 without any downtime 24
  25. 25. Scaling our decision support system 25
  26. 26. Massively Parallel Expert System Surveillance Results GigaSpaces Grid + Drools 26
  27. 27. Lessons Learned•Accelerate through partners•Procedural vs Declarative•Open Source 27

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