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Please Note: The technology listed below is not available to the public at this time. This technology is in the early stage of research and requires further development before it is ready for the marketplace. The VA is currently in the process of identifying potential companies who may be interested in licensing and/or further developing the technology through Cooperative Research and Development Agreements (CRADA). Through cooperative research initiatives such as these, it is our hope and goal that commercial products will be fully developed and made available to benefit veterans and others.
VA TECHNOLOGY OPPORTUNITY BRIEF
A Novel Architecture for the Computerized Patient Record Based on Modeling Physiology
OPPORTUNITY:
The Department of Veterans Affairs (VA) is seeking a commercial partner to further develop this technology through a Cooperative R&D Agreement (CRADA) to expedite bringing it to market.
BACKGROUND:
There is a growing desire and need for the medical database to assist care providers in decreasing medical errors, increasing patient safety and increasing the quality of patient care while also decreasing the cost of care. A major obstacle in developing more intelligent medical record systems is the archaic architecture of the clinical database. This architecture has been optimized, first as the paper and now as the electronic record, in a stove pipe design for efficient data entry at "functional points of care delivery process." This design has nothing to do with the organization needed to evaluate patient care. Thus, the current partitioning of the data within the medical record actually impedes the evaluation of care by distributing clinically related data throughout the paper or electronic patient record. This distribution throughout the medical record of the millions of data items in the medical vocabulary based on data entry also prevents the development of intelligent medical systems by leading to an exponential database design. The exponential rise in complexity in such a design limits the system's size, performance, and quality of the code.
TECHNOLOGY OVERVIEW:
VA has developed a radically new architecture based on an object oriented modeling (OOM) of systems biology including the functional concepts of cell biology and human physiology. The fundamental concepts in OOM are whole-part relationships, inheritance/specialization, "methods overloading," abstraction, and distributive processing partitioning all of which mirror the fundamental concepts in biology. The clinical architecture is partitioned based on the hierarchy of systems biology i.e. DNA, cellular components, cells, tissues, organs and organ systems. "Black Box" analysis confirms the strength of this architectural organization around biological system components.
At the whole organism level physiological systems are fundamental partitions. Communication between organs occurs principally through the biologically active components in blood and activity of the nervous system. Elements within organs are local and affect other organs only through their effects on global elements. Within organs, data can be further partitioned to tissues and cells. In addition, embryological and genetic knowledge can be incorporated using the OOM concept of inheritance.
In this architecture, data entry at the "function points in the care delivery process" is modeled as a review of physiological systems. Thus, the data is entered correctly in to the data model.
On top of this data model are placed the concepts of intelligent-agent communities to embody the knowledge of medical observation, coordination and intervention.
TECHNICAL MERIT:
The VA polynomial architecture minimizes partition interactions during clinical use of the data by modeling physiology. This same partitioning allows scaleable deployment utilizing grid computing. This structure will greatly facilitate the development of more sophisticated medical systems. It will enable the development of general systems capable of decreasing medical errors, increasing patient safety and increasing the quality of patient care while also decreasing the cost of care across a wide spectrum of medical specialties.
The architecture joins the 2 ends of medical sciences: bioinformatics (genetics) with medical informatics (health care delivery) by the use of a common architecture. This would allow treatments to be tailored to a patient's genetics. Thus, it assists with the speedy transfer of science into care.
As more basic biological knowledge is placed in the architecture, part of the system could be used in basic medical research. For example it could be used in studying the expected effects on new drugs based on drug structure in various disease states and identify potential interactions with other drugs and therapies. While such computer models are currently available for limited drug structures, this architecture could be used to integrate them into a more powerful modeling program.
Because the ultimate scope of this endeavor is to embed all biological knowledge into the database model, a major consideration is to define a starting point which limits this scope. For example one such implementation strategy would be to implement chronic disease guidelines. About 5 chronic diseases are associated with approximately 70% of the total cost of health care. Treating patients to these guidelines increases the quality of life and reduces the cost of care. A problem with the guidelines is that they have been developed for patients with only a single chronic disease. In the real world patients have multiple problems. With multiple diseases, following the "letter" of the guideline rather than the underlying science leads to inappropriate treatment. The VA model, because it is based on the science, will automatically handle such interactions.
PATENT STATUS:
No patent was filed for this invention. The VA is currently seeking CRADA partners to further develop this technology.
FOR MORE INFORMATION CONTACT:
Saleem Sheredos
Program Manager
Technology Transfer Program
Veterans Affairs
Office of Research & Development (12TT)
5th Floor
103 South Gay Street
Baltimore, MD 21202
202-380-5080
Fax 410.962.2141
e-mail: saleem.sheredos@va.gov