PPADS: Physician- PArent Decision-Support for NICU
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Transcript of PPADS: Physician- PArent Decision-Support for NICU
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Frize Bariciak Gilchrist Medinfo 2013
PPADS: Physician-PArent Decision-Support for NICU
Dr. Monique Frize, O.C., P. Eng., FIEEESystems and Computer Engineering (SCE) , Carleton University
Erika Bariciak, MDChildren’s Hospital of Eastern Ontario (CHEO)
Jeff Gilchrist, PhDAdjunct professor, SCE, Carleton University
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Frize Bariciak Gilchrist Medinfo 2013
Content
• Objectives (CDR, ANN, PPADS)
• Methodology
• Results
• Conclusion and Future Work
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Frize Bariciak Gilchrist Medinfo 2013
Objectives• Collect data from NICU patients in real-time
and store in Clinical Data Repository• Adapt our outcome estimation system to
processing real-time data• Develop PPADS: A decision-support module
for physicians and a module for parents.
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Clinical Data Repository Design
• Database uses open source MySQL and Entity-Attribute-Value format + time (EAVT).
• Confidential information separated from data for research.
• Study ID is used to associate patient ID with research data in an anonymous way
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Clinical Data Repository
Hospital Network
ADTSystem
HL7HL7
HL7
Clinical DataRepositoryHL7
MIRTH
MySQL Database
PrivatePatient
Data
De-IdentifiedMedical Data
Lab SystemPatient Monitors
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Outcome estimations
• Decision Trees and Artificial Neural Network
• Estimating Mortality
• Using real time data and summary data.
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Frize Bariciak Gilchrist Medinfo 2013
Methodology
• 1. Evaluation of CDR: storage, speed, complexityand pilot survey at hospital (MeMeA 2013)
• 2. Outcome estimationsCollected 85 million data points from 634 infants in NICU 2010 and 2011Admission (12 hrs), 24 hrs, 48 hrs5x2 cross validation approach Pre-processing and ANN analysis
• 3. Developed PPADS: Physician module and Parent module
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Frize Bariciak Gilchrist Medinfo 2013
Results--CDR
• CDR was better performing than the single EAV and the Multi-data type in terms of storage space, speed and complexity of query.
• Pilot test at CHEO with over 75 researchers and physicians: very positive results.
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Results– Outcome estimation
• Best results were obtained with data collected at 48 hours after admission.
• Mortality estimations: Specificity of 99 %; sensitivity of 63%;
PPV of 73%; and NPV of 98%... which meet our clinician’s expectations.
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Results-- PADS
PPADS: Identified criteria and mode of operation Examined standards, applied IPDAS Usability 8 parents and 5 neonatologists with very positive results.
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PPADS: Physician-Parent Decision Support
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Physician Module Summary Page
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Parent Module
• Patient management decision – Families bear: Emotional consequences
Financial consequences
• Collaborative care decisions
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Parent Account
• Home Page • Current condition • Current treatments • Outcome predictions • Decision support aid • Glossary
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Home Page Parents
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Outcome Estimation Example
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Decision-Support Process
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Conclusion and Future Work• CDR design de-identifies data automatically, uses opens-source tools
and easy to collect, store, and retrieve data.
• ANN performs better than Decision Trees; expanding to predict other outcomes (Length of stay, duration ventilation, IVH, BPD, NEC, ROP) with alerts.
– Future work: add input variables to improve performance.– Add warnings and alerts and perform usability study.
• PPADS well received by physicians and parents– Next phase: parents of infant who died; then randomised clinical trial with
parents of babies in NICU– More types of decisions will be added.
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Contact Information
• Monique Frize, P. Eng., O.C., FIEEE• Distinguished Professor, Carleton University• Systems and Computer Engineering• Ottawa Ontario Canada
• Email: [email protected]