While anemia is a common condition, it can be challenging to address because of its multifactorial and complex nature. As a result, diagnosis and management for some patients may be suboptimal. According to the Royal Society of Medicine, anemia is in many cases poorly assessed or not investigated and there are currently no defined national guidelines on management pathways. A shareable clinical pathway is a visual model that is both human readable and machine automatable. Such a standardized process can improve the efficiency and quality of anemia treatments through improved workflows and better clinical decisions. Automation allows routine tasks to be handled effectively, leaving more time to address complex cases, while the visual representation enables the transparency needed for all stakeholders to understand what has happened and why.

1. A shareable clinical
pathway for Anemia
ManagementAccelerating Clinical Quality
Dr. John Svirbely, MD
Chief Medical Informatics Officer (CMIO),
jsvirbely@Trisotech.com
Denis Gagne
Chief Executive Officer (CEO),
dgagne@Trisotech.com

2. Sharable Clinical
Pathways
A shareable clinical pathway is a visual decision model that is both
human readable and machine automatable.
Such a standardized workflow can improve the efficiency and quality
of healthcare processes.
We will demonstrate this by presenting models for the diagnosis
and management of anemia.

3. Our Objective
Promote the modeling of Clinical Guidelines using open standards to:
• Disambiguate Guidelines creation and interpretation
• Inform care coordination workflows
so that:
• Clinical Knowledge is delivered at the point of care
• A single visual Knowledge Artefact is created for clinicians and for automation

4. Established to foster the sharing and
promulgation of best-practices
around modeling and sharing:
• clinical pathways,
• clinical guidelines, and
• other healthcare knowledge
A robust and thriving community-
of-practice of healthcare
institutions, professional societies,
and vendors
www.BPM-plus.org

5. Introduction to BPM+
Open standards for machine interpretable models based on unambiguous graphical
notations visual languages (MN)
Language Provides Examples
BP (Business Processes) MN Process diagram Flow diagram, guideline
CM (Case Management) MN Unstructured
processes
Personalized patient care
D (Decision) MN Decision (trees) Decision tables, equations
www.OMG.org

6. Healthcare specific standards
A service that is invoked by the EHR via a Hook, evaluates its own
logic using FHIR data and returns decision support via Cards
Automate healthcare data sharing and improve patient care
www.HL7.org

7. International Open Standards Used

8. Anemia is a common, multifactorial and complex condition in
older people. In many, it is poorly assessed or not investigated,
and there are currently no defined national guidelines on
management pathways.
- Royal Society of Medicine

9. Clinical Scenario
• 57 year old female, post-menopausal
• History of chronic “arthritis”
• Mild deterioration in renal function
• On 6 chronic medications
• Negative stool guiac
• Hemoglobin 9.1 g/dL
• MCV 80 femtoliters

10. Problems faced by clinicians
NO TIME NO REIMBURSEMENT NO OBVIOUS ANSWER
AMONGST MANY POSSIBILITIES

11. Problem areas
Conditions with iron malabsorption like celiac disease
Anemia of chronic disease
Drugs
Hypoplastic bone marrow, NOS
Myelodysplasia
Non-sickling hemoglobinopathy
Hormonal disorders

12. Management of Anemia
Adjust
diagnosis and
treatment
plans
Monitor for
response
Treat
Identify
cause(s)
Narrow list of
causes
Establish
diagnosis

13. Establish Diagnosis
and Initial Triage

14. Decision Model
for Triage

15. Decision table
reducing the search
space
15

16. Refining the Diagnosis - Microcytic Anemia

17. Iron Replacement Therapy

18. Demo

19. Any questions?
THANKS!