Open SmartEMR Works

1. Open SmartEMR Works Ernie Chang ejhcmd@gmail.com

2. A New Kind of EMR A Knowledge Assistant

3. SmartEMR A Knowledge Assistant that preselects data and Guidelines, generates recommendations and lays out the Interface Patient Data

4. Fundamentals • Presentation at user-interface is tailored and dynamic • At-A-Glance Interface for status and actions • 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

5. Clinical Contexts

6. 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 • Includes possible medication changes, schedule of visits, possible tests, referrals, patient self-management education and tools needed • Generates access to resources • Generates interface • Generates recommendations • CustomizeDiabetes guideline • Filters and organizes data • Lab & other tests, medications, consults, imaging, reports from patient and other • Trends, graphs, and summaries to be generated for presentation • 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: sEMRguest@gmail.com Pwd: guest See: www.10screens.com

7. SmartEMR – Achievable? Very hard Very useful • At-A-Glance • Filtered and Organized Information • Loads of Data Complexity vs new effort needed Usefulness vs Amount of presentation needed

8. Strategies for Advancing • Instead of requiring each EMR to provide these capabilities, an alternate approach is to define a Standard Interface • 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 • 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 • Implement in Layers and small steps • Open Public Domain Approach – many shared efforts

9. TO PARTICIPATE • Contact: Ernie Chang at ejhcmd@gmail.com • 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