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OPEN SMARTEMR WORKS Ernie Chang ejhcmd@gmail .com A NEW KIND OF EMR Knowledge of clinical relationships in data elements Convenient ata-glance interface to status and actions Smart EMR Not just passive data elements Not just a search and retrieval engine Not just an SQL database A Knowledge Assistant Reasoning ability for Best Practices and Guidelines SMARTEMR Dynamic Presentation • Configures on-screen clinical information, reminders, actions using clinical status and guidelines Clinical Guidelines • Informs reminders, tasks, care plans and patient actions Clinical Context • Determines relevant data, knowledge relationships and guideline application A Knowledge Assistant that preselects data and Guidelines, generates recommendations and lays out the Interface FUNDAMENTALS At-A-Glance Interface for status and actions Presentation at user-interface is tailored and dynamic Easy for user to build mental model of patient Guidelines tailored by Clinical Context and Status Data filtered and organized into Clinical Status Clinical Context drives the encounter CLINICAL CONTEXTS Diabetes Asthma COPD Osteoarthritis Stroke Sore throat Urinary tract infection Depression Low Back Pain etc etc DIABETES CLINICAL CONTEXT •Presentation manager •Dynamic layout for presentation of status and actions to be taken •Optimize for ease of access •Zero-click for status •One-click for most actions •Lab & other tests, medications, consults, imaging, reports from patient and other •Trends, graphs, and summaries to be generated for presentation •Includes possible medication changes, schedule of visits, possible tests, referrals, patient self-management education and tools needed •Generates access to resources Generates interface Generates recommen dations Filters and organizes data Customize Diabetes guideline See: www.10screens.com If the patient has HgA1c < 8, the recommendations for HgA1c >8 clearly don’t apply and can be put aside for this clinical encounter userid: [email protected] Pwd: guest SMARTEMR – ACHIEVABLE? Very hard Very useful At-A-Glance Filtered and Organized Information Knowledge and Reasoning Clinical context and status SQL data Loads of Data Usefulness vs Amount of presentation needed Complexity vs new effort needed STRATEGIES FOR ADVANCING •Instead of requiring each EMR to provide these capabilities, an alternate approach is to define a Standard Interface Common Interface for EMRs •Implement in layers •Data layer for elements and entities •Information layer that relates eg metformin to diabetes •Knowledge layer that can parse guidelines and care plans •Presentation manager that can dynamically manage screen real estate for competing demands from knowledge agents •This would provide a means of mapping the elements needed in SmartEMR to the SQL access methods of a specific EMR system •The EMR vendor would provide the access methods for data elements needed by SmartEMR Implement in Layers and small steps Open Public Domain Approach – many shared efforts TO PARTICIPATE Contact: Ernie Chang at [email protected] Take the 10screens.com demo and share it with others Create your own Clinical Context demos Share ideas on how to move ahead – small steps, grand plans Believe it is achievable, and computing power is almost infinite, and knowledge engines, definitions and ontologies in health care are almost within reach