Pioneering Decision
Services with Decision
Modeling at Kaiser
Permanente
Building Business Capability BBC - Las
Vegas 2016
David Herring - BPM & ODM Delivery ManagerKaiser Permanente
James Taylor – CEO, Decision Management
Solutions
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Your Presenters
James Taylor
David Herring
• CEO, Decision
• Leads the Process
Management Solutions
Transformation and
Decision Management
• I have spent the last 14
Program at Kaiser
years focused on Business
Permanente
Rules, Analytics and
Decision Management
• Believes in developing
innovative techniques
• Published author,
that rapidly enhance
consultant, speaker
healthcare applications
without disrupting them
• Holds a Msc from HeriotWatt University,
Edinburgh in Digital
Systems & AI
© 2016 Kaiser Foundation Health Plan, Inc.
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Agenda
• About Kaiser Permanente
• Decision Management
• Decision Model and Notation
• Decision Modeling in Context
• Decision Management at KP
• Methodology in Practice
• Iterative Business-Centric Development
• One Decision, Many Documents
• Avoiding Overfitting
• Summary and Conclusions
• Q&A
© 2016 Kaiser Foundation Health Plan, Inc.
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About Kaiser Permanente
© 2016 Kaiser Foundation Health Plan, Inc.
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Kaiser Permanente
Integrated
Northwest
10.6 million members
17,000+ physicians
49,000+ nurses
Northern California
Colorado
Mid-Atlantic
Southern Cal ifornia
192,000+ employees
8 States + District of Columbia
Georgia
38 hospitals
600+ medical offices
Hawaii
$53 billion operating revenue
Nation’s largest not-for-profit health plan
Scope includes ambulatory, inpatient, ACS, behavioral health, SNF,
home health, hospice, pharmacy, imaging, laboratory, optical, dental, and insurance
© 2016 Kaiser Foundation Health Plan, Inc.
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Our Decision Management Journey
SOA Infrastructure
Enterprise Service Bus,
Message Broker, WSRR,
Web Services, APIs,
ITCAM, DataPower, WAS
Real Time In-Context
Decision Management
Operational Decision
Automation, Tactical Decision
Support, Rules using Location
and Time Dimensions
Business Process Management
Task Orchestration, Message
Notification, Document Generation, &
WS integration
Predictive Analytics
Predict Trends, Recognise
Patterns, Manage Risk,
Forecast Outcomes, Strategic
Decisions Based on Evidence
Complex Event Processing
Design and Develop a Robust Event-Centric
Enterprise Capable of invoking Business Rules
and integration with the IoT
© 2016 Kaiser Foundation Health Plan, Inc.
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Our Decision Management Journey
2 Billion messages per month
500 Enterprise Web Services
Decision Management
Performance Dashboards
Analytics Tools
Business Process
Management
Landing
Zone
Event
Platform
Other Data Sources
Events
SOA Messaging Bus
Pharmacy
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Kp.org
Mobile apps
Membership
Medical
Devices
Claims
Other
systems
EPIC
Decision Management and
Decision Modeling
© 2016 Kaiser Foundation Health Plan, Inc.
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A Decision Management Approach
Relies On Decision Modeling
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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A Decision Model Shows
Decision Requirements
D e c i si on
Pre ci se
D e c i si on
St ruc t ure
Kn ow l e d g e
I n form a t i on
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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A Decision Model Puts Decisions In Context
Organ
izatio
n
Depar
tment
Depar
tment
Motivation
Process
Team
Team
Role
Role
Organization
Person
Loan Appliation
0..*
-amount : Money
-amountLimit : Money
-facilityType : Enum
-id : String
-repaymentBy : Date
-status : Enum
-applicant
1
-guarantor
1..*
0.. 1
-address : String
-creditRtng : Enum
-dateOfBirth : Date
-disqualified : Boolean
-disqualificationReason : String
-firstName : String
-id : String
-middleInitials : String
-proofOfIdSeenBy : StaffId
-surname : String
-telephone : TelephoneNo
1
Pre-bureau risk category table
Decision
UC
1
Existing
Customer
1
Application
Risk Score
Pre-Bureau
Risk Category
< 100
HIGH
2
[100..120[
MEDIUM
3
[120..130]
LOW
> 130
VERYLOW
5
< 80
DECLINE
6
[80..90]
HIGH
7
[90..110]
MEDIUM
> 110
LOW
4
8
Financial Profile
-annualIncome : Money
-employmentRecord : Enum
-personalDebt : Integer
TRUE
FALSE
@jamet123 #decisionmgt
1
1
0..*
0..*
AssetLiability
-realisationDate : Date
-type : Enum
-value : Money
Employment
-endDate : Date
-salary : Money
-startDate : Date
-terminationReason : Enum
-workType : Enum
Data
© 2016 Decision Management Solutions
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A Decision Model Includes Two Layers of Detail
Decision Requirements
Decision Logic
Pre-bureau risk category table
UC
1
Existing
Customer
Application
Risk Score
Pre-Bureau
Risk Category
< 100
HIGH
2
[100..120[
MEDIUM
3
[120..130]
LOW
> 130
VERYLOW
5
< 80
DECLINE
6
[80..90]
HIGH
7
[90..110]
MEDIUM
> 110
LOW
4
8
TRUE
FALSE
Or Business Rules In
A BRMS
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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A Standard For Decision Models:
Decision Model and Notation (DMN)
▶ Open
Industry Standard
▶ Broad Vendor Support
▶
Decision Management Solutions, FICO, IBM, Oracle, TIBCO and others
▶ Object
Management Group
▶
BPMN, UML and many other established standards
▶
“… provide a common notation that is readily
understandable by all business users... DMN creates a
standardized bridge for the gap between the business
decision design and decision implementation.”
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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Many Use Cases
▶ Human
Decision-making
Documenting human decision-making
▶ Improving human decision-making with analytics
▶ Training human decision-makers
▶
▶ Requirements
for automated Decision-making
Business rules discovery and analysis
▶ Framing predictive analytics
▶ Dashboard design
▶
▶ Implementing
automated Decision-making
Completely specifying business rules
▶ Acting as a BRMS front-end
▶ Orchestrating complex decisioning technology
▶
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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Decision Modeling Lifecycle
Orchestration
Decision Requirements
Automation
Boundary
Traceability
▶ Decision
Technology Selection
Business
Rules
Predictive
Analytics
Implementation
Modeling
Drives requirements and automation
▶ Supports business rules and analytic implementations
▶ Delivers traceability
▶ Allows for ongoing orchestration
▶
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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Applying The Approach At
Kaiser Permanente
The Heart Failure Project
© 2016 Kaiser Foundation Health Plan, Inc.
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Heart Failure Project – Determine Survival Rate
Kaiser cardiologists have
a need for a system to
evaluate patients, using
a simple set of
conditions, to determine
if patient needs to be
referred to a heart
failure specialist.
© 2016 Kaiser Foundation Health Plan, Inc.
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Methodology in Practice
Model & Identify
Suitable Decision for
ODM
Discovery Workshop
Determine Survival Rate
Transform
Decision Models
into Decision
Tables
Deploy Decision Tables to Operational
Decision Manager ODM
© 2016 Kaiser Foundation Health Plan, Inc.
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Methodology in Practice - Discovery
Discovery Workshop
• Discover & Identify Decisions:
Brainstorming, Business Processes, KPI,
Business Events, Legacy Systems
• Map Decisions to KPI and Business
Objectives
• Understand Role of Decision in business
processes and in responding to business
events
© 2016 Kaiser Foundation Health Plan, Inc.
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Methodology in Practice - Modeling
Identify and Model Suitable Decision
• Model the decision & requirements using DecisionsFirst Modeler
• Refine a decision through decomposition into more granular, reusable decisions
© 2016 Kaiser Foundation Health Plan, Inc.
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Methodology in Practice - Design
Determine Survival Rate
Decision Table Design
• Use Modeling Principles to Normalize Rules
• Represent business rules with structured format
• Easy to Read & Interpret
• Simple to Manage
Determine Risk Score
© 2016 Kaiser Foundation Health Plan, Inc.
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Methodology in Practice - Deployment
ODM Decision Deployment
Decision Tables implemented as
Business Rules in IBM Operational
Decision Manager ODM
• Decision Service
• Decision Logic
© 2016 Kaiser Foundation Health Plan, Inc.
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Iterative Business-Centric
Development
© 2016 Kaiser Foundation Health Plan, Inc.
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An Initial High Level Model
© 2016 Kaiser Foundation Health Plan, Inc.
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A Detailed Clinical Model
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Model and Deploy Iteratively
▶ Build
high level models
▶ Model a decision in detail
▶ Document decision logic
▶ Repeat
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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One Decision Many Documents
© 2016 Kaiser Foundation Health Plan, Inc.
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Problems With Clinical Guidelines
Clinical Document
Guidelines
•
•
•
•
•
•
•
•
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Information Overload
Author not a practicing specialist
Specificity Varies
Implementation Varies
Regional Variation
Rarely Change
Not Connected to SMEs
Difficult to Maintain
National Guideline Clinical Guide
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National Guideline Summary
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Heart Failure Toolkit
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A New Approach
Studies &
Research
Evidence Based
Guidelines
Studies &
Research
Decision
Model
Additional Toolkits
National Library
National Library
Technical Designs
Regional Implementations
Technical Designs
Decision
Services
Shared
Guidance
Regional Implementations
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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Advantages Of New Approach
Clinical Decision Services
•
•
•
•
33
Extendable Shared Services
Clinical Support Applications
Modular Decision Logic
Avoids the need to eyeball complex docs in
real time
Avoiding Overfitting
© 2016 Kaiser Foundation Health Plan, Inc.
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Avoiding Noise and Overfitting
Patient Hemodynamic Status
• Not all decision outcomes need to be granular
• Real Time Decisions requiring expert judgment fit into this category
• Patient Hemodynamic Status is a Sub-Decision in Vasodilator Decision Model
• Requires a physician to physically examine a patient
• Outcomes break into 2 categories: (Wet or Dry), (Warm or Cold)
• Temptation to add additional categorization (like a 1-12 scale)
• Example of Overfitting, counter-productive and creates noise
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Manage Automation Boundaries
▶ Develop
a decision model
▶ Identify scope of automation
▶ “Feeder” decisions
Automated
▶ Overridable
▶ Manual
▶
@jamet123 #decisionmgt
© 2016 Decision Management Solutions
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Summary Conclusions and Recommendations
• Decision Modeling Workshops
• Engage Business Owners
• Reveal Automation Boundaries
• Integrate Multiple Perspectives and Documents
• Decision Modeling
• Supports Iterative Development
• Focuses BRMS Development
• Avoids Overfitting
• Decision Services
• Improve Processes
• Supports SOA Best Practices
© 2016 Kaiser Foundation Health Plan, Inc.
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Questions?
© 2016 Kaiser Foundation Health Plan, Inc.
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Contact Us
• David Herring
• [email protected]
• +1 650 339 5237
© 2016 Kaiser Foundation Health Plan, Inc.
• James Taylor
• [email protected]
• +1 650 400 3029
• decisionmanagementsolutions.com
• Come by the bookstore!
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