Posted by: Tony Shannon | May 31, 2017

Healthcare. Knowledge. Decision Support. GDL.

As we work to move healthcare into the 21st Century, much of the effort we see around us is piecemeal rather than pioneering.

An appointment of an individual here, a process improvement there, an app or application there, tweaks and twists in many cases, rather than significant steps forward. Such is the nature of all progress. Now and again an individual steps forward who does better than that, who shows how things can really be improved with a technical advancement that makes a real difference.

We hear a lot of about the pressure healthcare systems are under, we increasingly understand them as information intensive systems, we hear more about big data  and the forces of automation that will come and transform the professions, including healthcare. We see big showcase stuff like IBMs Watson as a taste of the future.

Yet a breakthrough in the field of healthcare and computing is happening around us that gets far less attention, that is the progress towards an open platform in healthcare.
One group that leads that field is the openEHR Foundation and one member of that group who leads the way is Dr Rong Chen.

Quietly, patiently, carefully Dr Chen (or Rong as I know him as) has been working towards a breakthrough in this area of healthcare, information, automation etc. That  is the gap between what I might describe as the information management aspects of healthcare (e.g. Joe Bloggs/John Doe and their Electronic Health Record material) and the knowledge management aspects of their care (e.g. latest evidence base on how to management their Hypertension, Asthma etc etc). This is known in the game as “Clinical Decision Support” and comes in a variety of flavours,.. passive decision support (eg publishing evidence, guidelines and pathways) and active decision support where you then build those guidelines into a computable format and try to support/influence the clinical decision making process.

Aside from the pros/cons of Active Clinical Decision Support ( there are both pros and cons) its fair to say this is tricky stuff to get right. In particular this is tricky stuff to scale and maintain. As I have written elsewhere I believe the solution to this and other challenges are a blend of open source and open standards and Rong has been working towards both.

Some years ago he outlined a proposal for GDL (Guideline Definition Language) which was related to /based on the openEHR ADL approach. This is not the first effort to tackle CDS, there has been Arden Syntax, PROforma etc beforehand, yet none have gone mainstream. In recent years he has been working away to progress this GDL work further. Then most recently he shared an update on this work..

For many of your this will be dry technical stuff, but bear this in mind… over the space of 10 months, Rong, his team at Cambio and a handful of medical/informatics students at the Karolinska Institute in Sweden have put together 100 Clinical Decision Support Apps built on this technology. For that reason alone, I am optimistic about the potential future of this technology.

If you take just one example , eg Glasgow Coma Scale (for use in Emergency Medicine) take a look at the app here

and the underlying GDL here;

Again this is tough technical stuff but it will give you a good idea of the effort involved and tools required to deliver 21st Century Healthcare at scale, bridging the gap between the clinical frontline and technical command line..

Kudos to Rong and his team for this pioneering work. Thanks to his open and innovative work that we all march on, smarter together!






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