{"id":91,"date":"2018-08-22T10:57:45","date_gmt":"2018-08-22T15:57:45","guid":{"rendered":"https:\/\/my.vanderbilt.edu\/janosmathe\/?page_id=91"},"modified":"2018-08-22T17:40:36","modified_gmt":"2018-08-22T22:40:36","slug":"sepsis-treatment-management-tool","status":"publish","type":"page","link":"https:\/\/my.vanderbilt.edu\/janosmathe\/projects\/sepsis-treatment-management-tool\/","title":{"rendered":"Sepsis Treatment Management Tool"},"content":{"rendered":"<p><font size=\"2\">Edited on 2018-08-22<\/font><\/p>\n<h3>Sepsis Treatment Enhanced through Electronic Protocolization (STEEP)<\/h3>\n<h2>Project Summary<\/h2>\n<div style=\"text-align: justify\">\nChallenges of sepsis management<\/p>\n<ul>\n<li style=\"text-align: justify\">\n<div>Sepsis is a common and lethal illness. Due to its nature, it is frequently managed in an intensive care unit (ICU) setting.<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>To achieve expected outcomes, sepsis management requires standardizing the care of patients using the readily available evidence-based guidelines.<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Coordination of care teams during treatment requires precise documentation of the state of the patient and treatment. (Knowledge Transfer)<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Changes to the evidence needs to be disseminated to both clinicians and clinical decision support (CDS) tools. (Knowledge Dissemination)<\/div>\n<\/li>\n<\/ul>\n<p>Goals: Support the overall clinical process by generating individualized care plans from evidence-based clinical protocols.<\/p>\n<ul>\n<li style=\"text-align: justify\">\n<div>Provide subject matter experts (SMEs) with a modeling environment for capturing best practice (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=20035219\" rel=\"noopener\" target=\"_blank\">Surviving Sepsis Campaign (SSC) guidelines<\/a>) in a formal manner.<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Use the resulting protocol models to implement actionable and customizable clinical decision support tools that aid the clinical treatment processes by tracking patient state and performed clinical actions.<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Enrich the solution with visual dashboards to show the status of the running guideline instances.<\/div>\n<\/li>\n<\/ul>\n<\/div>\n<h2>Results<\/h2>\n<div style=\"text-align: justify\">\nDeveloped jointly by <a href=\"http:\/\/www.truststc.org\">TRUST<\/a> and VUMC research teams, a fully model-integrated clinical decision support and patient management system, called Sepsis Treatment Enhanced through Electronic Protocolization (STEEP), was implemented. The work was funded by NSF-TRUST, NIH and VUMC.<\/p>\n<p><strong>Modeling<\/strong>: STEEP represented the sepsis management protocol using a custom domain-specific language.<\/p>\n<p><a href=\"https:\/\/cdn.vanderbilt.edu\/t2-my\/my-prd\/wp-content\/uploads\/sites\/1384\/2018\/08\/STEEP-Model-Based-UI.png\"><img decoding=\"async\" class=\"aligncenter size-full wp-image-65\" src=\"https:\/\/cdn.vanderbilt.edu\/t2-my\/my-prd\/wp-content\/uploads\/sites\/1384\/2018\/08\/STEEP-Model-Based-UI.png\" alt=\"Model-driven UI\" \/><\/a><\/p>\n<p style=\"text-align: center\"><em>Protocol model-driven UI<\/em><\/p>\n<p><strong>Implementation<\/strong>: The implementation included builing prototype tools for the detection and management of sepsis. These tools integrated with the current EHR systems and were configured through the protocol models.<\/p>\n<p><a href=\"https:\/\/cdn.vanderbilt.edu\/t2-my\/my-prd\/wp-content\/uploads\/sites\/1384\/2018\/08\/STEEP-Architecture.png\"><img decoding=\"async\" class=\"aligncenter size-full wp-image-65\" src=\"https:\/\/cdn.vanderbilt.edu\/t2-my\/my-prd\/wp-content\/uploads\/sites\/1384\/2018\/08\/STEEP-Architecture.png\" alt=\"STEEP Architecture\" \/><\/a><\/p>\n<p style=\"text-align: center\"><em>STEEP Architecture<\/em><\/p>\n<p><strong>Evaluation<\/strong>: VUMC performed randomized trials for both detection (real-time alerting of modified SIRS criteria) and management of sepsis (using the sepsis protocol). However, due to various suspected causes neither solution influenced guideline compliance or clinical outcomes.\n<\/div>\n<h2>Contribution<\/h2>\n<ul>\n<li style=\"text-align: justify\">\n<div>Domain analysis, documentation<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Solution architecture design<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Domain model development<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Domain modeling tool configuration and user education<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Model translator creation for analysis, verification and visualization<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Simulation and verification engine implementation<\/div>\n<\/li>\n<li style=\"text-align: justify\">\n<div>Contributed to UX (user experience) design<\/div>\n<\/li>\n<\/ul>\n<h2>Publications<\/h2>\n<p>Semler, M.W.; Weavind, L.; Hooper, M.H.; Rice, T.W.; Gowda, S.S.; Nadas, A.; Song, Y.; Martin, J.B.; Bernard, G.R.; Wheeler, A.P. <font color=\"#009922\">An Electronic Tool for the Evaluation and Treatment of Sepsis in the ICU: A Randomized Controlled Trial<\/font>. Crit Care Med 43, 1595\u20131602 <strong>2015<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong> <a href=\"http:\/\/etd.library.vanderbilt.edu\/available\/etd-11192012-144514\/\"><font color=\"#009922\">The Precise Construction of Patient Protocols: Modeling, Simulation and Analysis of Computer Interpretable Guidelines<\/font><\/a>. Vanderbilt University, Nashville, TN <strong>2012<\/strong>.<\/p>\n<p>Hooper, M.H.; Weavind, L.; Wheeler, A.P.; Martin, J.B.; Gowda, S.S.; Semler, M.W.; Hayes, R.M.; Albert, D.W.; Deane, N.B.; Nian, H.; <strong>Mathe, J.L.<\/strong>; Nadas, A.; Sztipanovits, J.; Miller, A.; Bernard, G.R.; Rice, T.W. <font color=\"#009922\">Randomized Trial of Automated, Electronic Monitoring to Facilitate Early Detection of Sepsis in the Intensive Care Unit<\/font>. Crit. Care Med. In press, 2096\u20132101 <strong>2012<\/strong>.<\/p>\n<p>Miller, A. <a href=\"http:\/\/www.cs.umd.edu\/hcil\/sharp\/workshop2011\/Miller,Anne-EHR-HCILseminar.pdf\"><font color=\"#009922\">Alerts and Reminders: Is This All There is to Clinical Decision Support?<\/font><\/a>. Presented at the 28th Human-Computer Interaction Lab Symposium (HCIL 2011), University of Maryland, Maryland, USA <strong>2011<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Werner, J.; Sztipanovits, J. <a href=\"https:\/\/books.google.com\/books?hl=en&amp;lr=&amp;id=LjAs2Jrco00C&amp;oi=fnd&amp;pg=PR5&amp;ots=bys-T-pN_V&amp;sig=VuLf4WI-6VY-nGQqW0YMfNY9U54#v=onepage&amp;q&amp;f=false\"><font color=\"#009922\">Model-Based Design of Trustworthy Health Information Systems<\/font><\/a>, in: Homeland Security Facets: Threats. Countermeasures, and the Privacy Issue. Artech House, London, UK, pp. 119\u2013134 <strong>2011<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Nadas, A.; Sztipanovits, J. <a href=\"http:\/\/www.truststc.org\/pubs\/768.html\"><font color=\"#009922\">A Model-Integrated, Guideline-Driven, Clinical Decision-Support System<\/font><\/a>. Presented at the TRUST Review Meeting, Stanford, CA, USA <strong>2010<\/strong>.<\/p>\n<p>Hooper, M.H.; Martin, J.B.; Weavind, L.M.; Semler, M.W.; Albert, D.W.; Deane, N.B.; Paulett, J.M.; <strong>Mathe, J.L.<\/strong>; Miller, A.; Wheeler, A.P.; Bernard, G.R.; Rice, T.W. <a href=\"https:\/\/www.atsjournals.org\/doi\/abs\/10.1164\/ajrccm-conference.2010.181.1_MeetingAbstracts.A6137\"><font color=\"#009922\">Automated Surveillance Of Modified SIRS Criteria Is An Effective Tool For Detection Of Sepsis In The Medical Intensive Care Unit<\/font><\/a>, in: D53. SEPSIS: MECHANISMS AND IMPLICATIONS FOR MANAGEMENT, American Journal of Respiratory and Critical Care Medicine 2010. Presented at the American Thoracic Society 2010 International Conference, American Thoracic Society, New Orleans, pp. A6137\u2013A6137 <strong>2010<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Martin, J.; Hooper, M. <a href=\"http:\/\/www.truststc.org\/pubs\/648.html\"><font color=\"#009922\">Towards an Adaptable Framework for Modeling, Verifying, and Executing Medical Guidelines<\/font><\/a>. Presented at the TRUST Review Meeting, Washington, D.C. <strong>2009a<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong> <font color=\"#009922\">Towards an Adaptable Framework for Modeling, Verifying, and Executing Medical Guidelines<\/font>, in: Proceedings of the Doctoral Symposium at MODELS 2009. Presented at the ACM\/IEEE 12th International Conference on Model Driven Engineering Languages and Systems (MODELS \u201909), Denver, CO <strong>2009<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Martin, J.; Miller, P.; Ledeczi, A.; Weavind, L.; Nadas, A.; Miller, A.; Maron, D.; Sztipanovits, J. <font color=\"#009922\">A Model-Integrated, Guideline-Driven, Clinical Decision-Support System<\/font>. IEEE Softw. 26, 54\u201361 <strong>2009b<\/strong>.<\/p>\n<p>Salisbury, D.F. <a href=\"http:\/\/sitemason.vanderbilt.edu\/news\/releases\/2009\/06\/15\/vanderbilt-doctors-and-software-engineers-pioneer-an-advanced-sepsis-detection-and-management-system.82615\"><font color=\"#009922\">Vanderbilt doctors and software engineers pioneer an advanced sepsis detection and management system<\/font><\/a>. VUCast Vanderbilt University\u2019s News Network <strong>2009<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Martin, J.B.; Miller, P.; Ledeczi, A.; Weavind, L.; Miller, A.; Maron, D.J.; Nadas, A.; Sztipanovits, J. <font color=\"#009922\">STEEP &#8211; A Model-Integrated Clinical Information System Application<\/font>. Presented at the TRUST Review Meeting, Berkeley, CA <strong>2009c<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Martin, J.; Miller, P.; Ledeczi, A.; Weavind, L.; Miller, A.; Maron, D.; Nadas, A.; Sztipanovits, J. <a href=\"http:\/\/www.truststc.org\/pubs\/529.html\"><font color=\"#009922\">STEEP &#8211; A Model-Integrated Clinical Information System Application<\/font><\/a>. Presented at the TRUST Review Meeting, Nashville, TN <strong>2008a<\/strong>.<\/p>\n<p><strong>Mathe, J.L.<\/strong>; Martin, J.; Miller, P.; Weavind, L.; Maron, D.; Ledeczi, A.; Miller, A.; Nadas, A.; Sztipanovits, J. <a href=\"http:\/\/www.truststc.org\/pubs\/522.html\"><font color=\"#009922\">A Model-Integrated Approach to Implementing Individualized Patient Care Plans Based on Guideline-Driven Clinical Decision Support and Process Management<\/font><\/a>. Presented at the TRUST Review Meeting, Nashville, TN <strong>2008b<\/strong>.<\/p>\n<p>Martin, J.; <strong>Mathe, J.L.<\/strong>; Miller, P.; Ledeczi, A.; Weavind, L.; Miller, A.; Maron, D.J.; Nadas, A.; Sztipanovits, J. <font color=\"#009922\">A Model-Integrated Approach to Implementing Individualized Patient Care Plans Based on Guideline-Driven Clinical Decision Support and Process Management &#8211; A Progress Report<\/font>, in: 2nd International Workshop on Model-Based Design of Trustworthy Health Information Systems (MOTHIS 2008). Presented at the MOTHIS 2008 Workshop @ MODELS, Toulouse, France <strong>2008<\/strong>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Edited on 2018-08-22 Sepsis Treatment Enhanced through Electronic Protocolization (STEEP) Project Summary Challenges of sepsis management Sepsis is a common and lethal illness. Due to its nature, it is frequently managed in an intensive care unit (ICU) setting. To achieve expected outcomes, sepsis management requires standardizing the care of patients using the readily available evidence-based&#8230;<\/p>\n","protected":false},"author":2793,"featured_media":250,"parent":41,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"tags":[],"class_list":["post-91","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/pages\/91","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/users\/2793"}],"replies":[{"embeddable":true,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/comments?post=91"}],"version-history":[{"count":33,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/pages\/91\/revisions"}],"predecessor-version":[{"id":282,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/pages\/91\/revisions\/282"}],"up":[{"embeddable":true,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/pages\/41"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/media\/250"}],"wp:attachment":[{"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/media?parent=91"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/my.vanderbilt.edu\/janosmathe\/wp-json\/wp\/v2\/tags?post=91"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}