Kensaku Kawamoto, MSIII

by Jim Rogalski

A Duke medical student has received international approval for a breakthrough in computer software that allows physicians to share clinical patient information and receive treatment guidelines based on the latest medical research.

Kensaku Kawamoto, MSIII, 29, has developed a computer program named SEBASTIAN that takes in patient data in a standardized format, analyzes the data using clinical algorithms based on the latest research findings, and generates care recommendations in a standardized format. These patient-specific care recommendations can then be communicated to clinicians through various clinical software applications, such as an electronic health record system or a computerized physician order entry system.

“SEBASTIAN can help to make the practice of evidence-based medicine a reality,” Kawamoto says. “For example, SEBASTIAN can provide clinicians with patient-specific care recommendations based on a variety of evidence-based practice guidelines, such as health maintenance guidelines from the U.S. Preventive Services Task Force, diabetes care guidelines from the American Diabetes Association, and cholesterol management guidelines from the National Cholesterol Education Program.”

Through a collaborative effort with Duke Health Technology Solutions, SEBASTIAN is currently being used by Duke University Health System to provide physicians with diabetes management advice through the health system's e-Browser patient data viewer.

In addition, SEBASTIAN is being used in five North Carolina counties—including Durham —to provide population health management assistance to the care providers of some 36,000 Medicaid patients.

"...SEBASTIAN can provide clinicians with patient-specific care recommendations based on a variety of evidence-based practice guidelines..." Kensaku Kawamoto, MSIII

Kawamoto, who is taking time off before his fourth year in the Duke MD/PhD program to do research in Duke's Division of Clinical Informatics in the Department of Community and Family Medicine, says “taking the latest medical knowledge and applying it against a patient's health records can help physicians get patient-specific advice to improve their decision making.”

It is a concept that has long been a goal of the medical industry worldwide, and the software framework based on SEBASTIAN has been adopted as the standard for how such systems should work by Health Level 7 (HL7), the primary international organization charged with creating standards for the exchange and management of electronic health care information. Kawamoto led an international project team to develop and achieve international acceptance of the 118 page standard, known as the HL7 Decision Support Service standard.

“The whole issue of being able to share information is critical,” says David Lobach, MD'84, PhD'86, HS'87-'92, chief of Clinical Informatics in Duke's Department of Community and Family Medicine, who first envisioned such a software program seven years ago. “One of the main limitations has been that there are a bunch of systems but none of them can talk to each other. Ken took this vision and put legs on it.”

SEBASTIAN defines the structure for sharing information, Lobach says. “So if one institution is sharing information with another institution, the recipient institution will know how the information will be structured when it receives it.”

In the case of the use of SEBASTIAN within the Duke e-Browser, the most up-to-date research is reviewed by Duke's Chronic Disease Management Advisory Committee, which decides on the clinical guidelines that should be used. Kawamoto then encodes the specified clinical guidelines into a computable form for use in the e-Browser system. Based on that latest research, SEBASTIAN may recommend a treatment for a patient that might not have otherwise been known to the physician.

“The value going forward as an HL7 standard,” Lobach says, “is that SEBASTIAN provides a way for computerized care guidelines to be shared across institutions through a standard approach. That's the global value of what we've done.”

Lobach added that the next step is to set up a small-scale national system. He is discussing the concept with a national nephrology organization to establish a nationwide system for the treatment and care of patients with kidney disease.