A Collection of DMN-Based CDSS for Sharable Clinical Guidelines - Bootstrapping the Ecosystem Jonh Svirbely and Denis Gagne

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The document describes a collection of 510 clinical decision support systems (CDSS) created using Decision Model and Notation (DMN) to bootstrap the BPM+ Health initiative. The CDSS are implemented as DMN decision services across 90 clinical categories and standardized using Open API and CDS Hook. The goal was to make these widely available to drive adoption of BPM+ services. A beta version of the toolbox is available for request, providing search and documentation of the decision services and examples of usage through REST API endpoints. Future work areas include standardizing terminology, aligning to FHIR, testing, certification, and addressing liability issues.

Business

A Collection of
DMN-Based CDSS for
Sharable Clinical Guidelines
Bootstrapping the BPM+ ecosystem with a DMN Health Toolbox
Denis Gagné
CEO & CTO, Trisotech
John Svirbely
MD

Our belief
 The success of the BPM+ Health initiative will be
measured by the availability and adoption of its
services
 Wide availability of existing BPM+ models will
drive adoption

DMN-Based CDSS
Our goal was to:
 Create a large collection of Clinical Decision
Support Systems (CDSS) using the Decision Model
and Notation (DMN)
 Categorize our development by clinical problem

Toolbox Current Status
 The resulting CDSS are implemented as DMN
Decision services
 These Decision Services offer restful endpoints that
are standardized using Open API and CDS Hook
 To date we created 510 Decision Services in 90
different clinical categories

Sample of problem categories
 Abuse
 Adrenal gland disorders
 Alcohol use disorders
 AMI and chest pain
 Anemia
 Antibiotic resistant pathogens
 Appendicitis
 Asthma
 Atrial fibrillation
 Bleeding
 Blood transfusion
 Body dimensions
 Burns
 C-section
 Carbon monoxide poisoning
 Cardiac arrest
 Chemistry calculators
 Cirrhosis
 Clostridium difficile disease
 Coma
 … +70 more

Simply Request Access
 Beta availability
 Highly moderated
 Not yet fit for
production

Grouped for Convenience
 Groups represent
problem categories

Help and Feedback
 Make requests for
other/missing
Decision Models
 Provide Feed Back

Easy to Use Search
 Search within model
names and descriptions
 Search is context
sensitive to category

Details of Each Decision Service
 Complete Model
Documentation
 Contextual Feed
Back

Various Service End Points including
CDS Hook Discovery
 Ready to be used by
external app Calls
 Note that to consume the
services from an external
app you will need to
request a token via the
Feedback button

Process calling a Decision service from
cds.Trisotech.com

Future work to address
 Standardizing terminology
 Introduction of a common dictionary of terms for the catalogue
 Disambiguation using existing health ontologies
 Interoperability
 Aligning to FHIR
 For data interchange
 For Questionnaires structure
 Currently the burden falls on the organization calling the service
 Simplifying integration for the end user

Future work to address
 Testing
 How do we certify the models provided (from beta to production)
 Turn the catalogue in to a market place
 Explore HSPC’s market place proposal
 Liability
 Of the current library
 FDA software regulation (burden on the calling app)
 If someone modifies the model, do they become liable?

Questions?
Denis Gagné
CEO & CTO, Trisotech
dgagne@Trisotech.com
John Svirbely
MD
johnsvirbely@gmail.com

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