Regenstrief New Gopher - Med Info 2013

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Updated report on features of the Regenstrief New Gopher System

Text of Regenstrief New Gopher - Med Info 2013

  • 1. Regenstrief Institutes New Medical Gopher: A Next-Generation Open-Source Physician Order Entry System Jon D. Duke, MD, MS Burke Mamlin, MD Doug Martin MD MedInfo 2013

2. Gopher Gopher grew from a single clinic to over 1000 workstations, inpatient, outpatient, ED 25+ years of iterations has resulted in robust functionality and efficiency Served as the research platform for many of the seminal studies in healthcare computing 3. 1984 2010 4. In 2009 Regenstrief Institute began rebuilding its core clinical information system platform In 2010, we began work on a new web-based version of the venerable Gopher This system was designed using the knowledge gained from the past 25 years of Gopher as well as from the evolving literature on CPOE system design Developing the new Gopher 5. Started with a Blank Slate 6. Improve User Satisfaction Support Patient Safety Improve Quality of Care Promote Provider Efficiency Guiding Principles 7. Set Gravity in the Right Direction Leverage Metaphors Constrain Then Innovate Design Strategies 8. Leverage Metaphors 9. Leveraging Metaphors 10. Leveraging Metaphors 11. Leveraging Metaphors 12. E-Commerce 13. Workflow Wizards 14. Smart Autocompletion 15. Constrain Then Innovate 16. 140 characters hashtags retweets url shorteners brevity Instagram Vine Yammer Waze 17. Screen Real Estate At outset of development process, set aside an untouchable area of screen real estate That area the InfoPanel was not utilized for >1 year into development but has become a critical asset 18. Set Gravity in the Right Direction 19. Right Thing Wrong Thing UserUser 20. Formulary Recognition 21. Allergy Entry 22. Fitts Law 23. Whats inside the new Gopher? 24. Major Functions Order entry Documentation / note writing Medication / problem / allergy management Results viewing Research Clinical decision support 25. Advancements in New Gopher Context-Driven Dynamic Alerts Adaptive Learning Real-time Natural Language Processing Multimedia Alerts Advanced Rule Authoring 26. Advancement #1: Dynamic Alerts Gopher has embedded mechanics to dynamically change alert display based on context Patient Physician Institutional 27. Alerting Zones 28. Relevance Adjustment Module Every alert has a baseline relevance level which determines its display location For example, for DDI alerts, about 40% are interruptive and 60% non-interruptive The RAM can adjust this default level 29. DDI Alert Service DDI Alert Service TRIAMTERENE Interacts with LISINOPRIL Risk of Hyperkalemia Severity: Moderate Relevance: 5 (Average) TRIAMTERENE Interacts with LISINOPRIL Risk of Hyperkalemia K 5.3*, Cr 1.3, GFR 55 Relevance: 7 (High) Lisinopril Order Related Concepts Related Concepts Hyperkalemia Has Relevant Labs: K, Cr, GFR Data Repository Data RepositoryK, Cr, GFR Relevance Adjustment ModuleRelevance Adjustment Module Original Alert Final Alert Patient has lab values: K 5.3*, Cr 1.3, GFR 55 30. DDI Alert Service DDI Alert Service TRIAMTERENE Interacts with LISINOPRIL Risk of Hyperkalemia Severity: Moderate Relevance: 5 (Average) TRIAMTERENE Interacts with LISINOPRIL Risk of Hyperkalemia K 3.3, Cr 0.8, GFR 114 Relevance: 3 (Low) Lisinopril Order Related Concepts Related Concepts Hyperkalemia Has Relevant Labs: K, Cr, GFR Data Repository Data RepositoryK, Cr, GFR Relevance Adjustment ModuleRelevance Adjustment Module Original Alert Final Alert Patient has lab values: K 3.3, Cr 0.8, GFR 55 31. Relevance Adjustment Module RAM can also make changes based on provider characteristics For example, can make particular alerts non- interruptive for certain specialties Conversely, for medical students all alerts can be made interruptive 32. TM Nintendo Advancement #2: Gopher is a Learning System 33. Advancement #2: Gopher is a Learning System Gopher can track user actions and activity such as Number of logins Frequently selected orders Responses to previous alerts Can customize system behavior based on individual user history 34. Alerts That Learn Picture of learning message, then another of the small alert Diazepam Diazepam 5 MG 35. Alerts That Learn Diazepam Diazepam 5 MG 36. Advancement #3: Natural Language Processing Gopher can analyze notes in real-time Can determine section (e.g., FHx, PMH) to give context to the concepts retrieved Multiple services may be run simultaneously (e.g.,CDS, quality metrics, study recruitment) Results may be displayed as alert or used for background data capture Section header detection thanks to SecTag from Vanderbilt University: http://knowledgemap.mc.vanderbilt.edu/research/content/sectag-tagging-clinical-note-section-headers 37. Order Detection 38. Study Reminders 39. Natural Language Processing Can be used as a CDS trigger Can be used to enhance structured documentation for meaningful use Can be used for clinical research Integrated with our Advanced Rule Authoring environments 40. Advancement #4: Multimedia Alerts 41. Adherence Information 42. Research Study Eligibility 43. Advancement #5: Advanced Rule Authoring The Rule Authoring and Validation Environment (RAVE) is a rule authoring tool within Gopher The RAVE is designed to empower stakeholders to create complex, rule-based actions using a simple graphical interface 44. Rule Authoring Rules are necessary to drive decision support logic as well as other system actions Rule authoring is generally a complex task requiring code-like syntax 45. Good artists copy. Great artists steal. - Pablo Picasso 46. ifttt.com 47. Great Artists Steal 48. RAVE = IFTTT for EMRs Built a variety of channels for EMR activities Channels may server as Triggers (If) Actions (Then) Both Additionally, we added a For component to specify when the rule should be run 49. Rule Authoring and Validation Environment Picture HERE 50. Rule Authoring and Validation Environment Picture HERE 51. Rule Authoring and Validation Environment Picture HERE 52. RAVE Channels If Channels Orders Diagnoses Allergies Note NLP Chart Actions Observations ADT HL7 Then Channels Alerts Email / SMS Logging Observations For Channels Patient User 53. FOR: Patient Channel Picture HERE 54. IF: Diagnosis Channel Picture HERE 55. THEN: Alert Channel Picture HERE 56. RAVE Output Picture HERE 57. RAVE Output Picture HERE 58. RAVE DROOLS Syntax Picture HERE 59. Rule Authoring and Validation Environment 60. RAVE = Customizability Can mix and match channels to create a remarkable array of functionality without need for programmer intervention Can write rules just for yourself or (with permission) your clinic, specialty, or all users Rule syntax is generated automatically in a standard rules syntax (Drools) 61. Gopher Demo 62. Gopher and Open Source Regenstrief is philosophically and contractually committed to release of the new Gopher platform as open source software We are looking for partners to take part in both software development and community building around this effort Please let us know if this is something you would be willing to commit time and energy to pursuing 63. Acknowledgements Chris Beesley Chris Bonham Mike Brehm Jason Cadwallader Joshua Castagno Vidhya Chari Parishkar Chauhan Ling Cheng Sireesha Chilukuri Cyril Colvard Jonathan Cummins Alex Franken Cindi Hart Charity Hilton Joshua Jones Warren Killian Jeremy Leventhal Allen Logan Ernesto Maldonado Burke Mamlin Andrew Martin Doug Martin Jim Meeks-Johnson Pat Milligan Justin Morea Chris Power Linas Simonaitis Kenneth Spry Jeff Stroup Blaine Takesue David Taylor Jeff Warvel Jennifer Weatherspoon Chen Wen 64. Questions? jduke@regenstrief.org