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DR ANTHONY MADDEN Consultant Anaesthetist
& ACIS Programme DirectorNorth Bristol NHS Trust
CLINICAL DECISION SUPPORT AND
PROGRAMMING IN ARDEN SYNTAX
• to explain the term ‘Clinical Decision Support' in the context of EPR/EHR
• to explain why we need CDS
• to explain what Arden Syntax is
• to introduce programming medical logic modules in Arden Syntax
AIMS
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden Syntax
CLINICAL DECISION SUPPORTCLINICAL DECISION SUPPORT
“Pull Technology”•Medline•Embase•NELH• Internet•WeBNF
CLINICAL DECISION SUPPORTCLINICAL DECISION SUPPORT
“Push Technology”•Notes•Order sets•Care pathways•Expert systems
•Arden Syntax
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden Syntax
CLINICIANS NEED INFORMATION AT THE POINT OF
CARE
“If we managed travel like we manage healthcare then travel agents would book flights on the basis of the flight schedules they could remember"
Lawrence L WeedLawrence L Weed
HOSPITAL FATALITY HOSPITAL FATALITY RATERATE
“In the USA medical error results in 44,000-98,000 unnecessary deaths each year and 1,000,000 excess injuries”
Epidemiology of medical errorBMJ 18 March 2000
EFFECTIVENESS OF CDSSEFFECTIVENESS OF CDSS
Perioperative Antibiotic Administration
• Intervention : reminder re timing and type of antibiotic
• Period : 1988 - 1994• Result : perioperative wound infections
declined from 1.8% to 0.9%• average # doses : 19 to 5.3• antibiotic cost per patient: $123 to $52(Pestotnik, LDS Hospital: Ann Intern Med 1996;124(10):884-90)
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden Syntax
MEDICAL LOGIC MODULEMEDICAL LOGIC MODULEMEDICAL LOGIC MODULEMEDICAL LOGIC MODULE
• Each MLM contains maintenance information, links to other sources of knowledge, and enough logic to make a single health decision
• The Medical Logic Module (MLM) is a stream of text stored in an ASCII file in statements called slots
ARDEN SYNTAX - DEFINITION
ARDEN SYNTAX - DEFINITION
Arden Syntax is an HL7/ANSI standard specification for defining and sharing medical logic. It is a programming language.
Current approved version is 2.1
ARDEN SYNTAX - HISTORYARDEN SYNTAX - HISTORYARDEN SYNTAX - HISTORYARDEN SYNTAX - HISTORY
HELPLDS Hospital
Salt Lake City, UT
CARERegenstrief Institute
Indianapolis, IN
Arden Syntax
Retreat at Arden Homestead, Harriman, NY 1989
Arden SyntaxArden Syntax
• Version 1: 1992 ASTM document 1460
• Version 2: 1999 HL7/ANSI• Version 2.1 : 2002 HL7/ANSI
SUPPORT FOR ARDEN SUPPORT FOR ARDEN SYNTAXSYNTAX
• Eclipsys / iSoft
• McKessonHBOC
• Siemens
• Cerner
• IBM
• SMS
• Epic Systems
• Micromedex
Arden: New InitiativesArden: New Initiatives
• Structured Write statement: - XML DTD
• Representing MLMs in XML
• Data Model: Fuzzy logic, standard expression language, etc
• Clinical Decision Support
• Why we need CDS
• Arden Syntax
• Programming ‘medical logic modules’ in Arden Syntax
MLM - StructureMLM - StructureMLM - StructureMLM - Structure
Categories & Slots maintenance:
slotname: slot-body;;
library:slotname: slot-body;;
knowledge:slotname: slot-body;;
end:
Maintenance Category Slots Maintenance Category Slots (9(9))
Maintenance Category Slots Maintenance Category Slots (9(9))
•Title•Mlmname (formerly called filename)
•Arden•Version• Institution•Author•Specialist•Date•Validation
Library Category Slots (5)Library Category Slots (5)Library Category Slots (5)Library Category Slots (5)
• Purpose • Explanation• Keywords• Citations (optional)• Links (optional)
Knowledge Category Slots Knowledge Category Slots (7)(7)
Knowledge Category Slots Knowledge Category Slots (7)(7)
•Type•Data*•Priority•Evoke•Logic*•Action•Urgency
Data SlotData SlotData SlotData Slot
•Terms in the medical logic module must be mapped to a database
•Use of curly braces { } allows flexibility in mapping to the institution’s local database
•Mapping terms in this way separates the logic in the MLM from institution-specific information
Logic SlotLogic SlotLogic SlotLogic Slot
• Logical algorithm ‘If…….then…..’
• Ends with a “conclude statement”
conclude true; orconclude false;
Conclude StatementConclude StatementConclude StatementConclude Statement
• conclude true;
terminates the rule go to the action slot
• conclude false;
terminates the rule do not go to the action slotgo to end;;