Real-Time Identification of Performance Problems in Large Distributed Systems

2016 ◽  
pp. 339-362
Author(s):  
Moises Goldszmidt ◽  
Dawn Woodard ◽  
Peter Bodik
Keyword(s):  
Distributed Systems ◽  
Real Time ◽  
Performance Problems ◽  
Real Time Identification

scholarly journals Real-Time Identification of Patients Included in the CMS Bundled Payment Care Improvement (BPCI) Program

2020 ◽  
Vol 41 (S1) ◽  
pp. s367-s368
Author(s):  
Michael Korvink ◽  
John Martin ◽  
Michael Long
Keyword(s):  
Performance Evaluation ◽  
Real Time ◽  
Naive Bayes ◽  
Naïve Bayes ◽  
Care Providers ◽  
Meta Model ◽  
Bundled Payment ◽  
Clinical Cohort ◽  
Real Time Identification ◽  
Care Improvement

Background: The Bundled Payment Care Improvement Program is a CMS initiative designed to encourage greater collaboration across settings of care, especially as it relates to an initial set of targeted clinical episodes, which include sepsis and pneumonia. As with many CMS incentive programs, performance evaluation is retrospective in nature, resulting in after-the-fact changes in operational processes to improve both efficiency and quality. Although retrospective performance evaluation is informative, care providers would ideally identify a patient’s potential clinical cohort during the index stay and implement care management procedures as necessary to prevent or reduce the severity of the condition. The primary challenges for real-time identification of a patient’s clinical cohort are CMS-targeted cohorts are based on either MS-DRG (grouping of ICD-10 codes) or HCPCS coding—coding that occurs after discharge by clinical abstractors. Additionally, many informative data elements in the EHR lack standardization and no simple and reliable heuristic rules can be employed to meaningfully identify those cohorts without human review. Objective: To share the results of an ensemble statistical model to predict patient risks of sepsis and pneumonia during their hospital (ie, index) stay. Methods: The predictive model uses a combination of Bernoulli Naïve Bayes natural language processing (NLP) classifiers, to reduce text dimensionality into a single probability value, and an eXtreme Gradient Boosting (XGBoost) algorithm as a meta-model to collectively evaluate both standardized clinical elements alongside the NLP-based text probabilities. Results: Bernoulli Naïve Bayes classifiers have proven to perform well on short text strings and allow for highly explanatory unstructured or semistructured text fields (eg, reason for visit, culture results), to be used in a both comparative and generalizable way within the larger XGBoost model. Conclusions: The choice of XGBoost as the meta-model has the benefits of mitigating concerns of nonlinearity among clinical features, reducing potential of overfitting, while allowing missing values to exist within the data. Both the Bayesian classifier and meta-model were trained using a patient-level integrated dataset extracted from both a patient-billing and EHR data warehouse maintained by Premier. The data set, joined by patient admission-date, medical record number, date of birth, and hospital entity code, allows the presence of both the coded clinical cohort (derived from the MS-DRG) and the explanatory features in the EHR to exist within a single patient encounter record. The resulting model produced F1 performance scores of .65 for the sepsis population and .61 for the pneumonia population.Funding: NoneDisclosures: None

XERIS/APEX

2021 ◽  
Vol 40 (2) ◽  
pp. 65-69
Author(s):  
Richard Wai
Keyword(s):  
Distributed Systems ◽  
Real Time ◽  
Distributed System ◽  
Dynamic Scaling ◽  
Distributed Application ◽  
Heavy Weight ◽  
System Models ◽  
In The Wild ◽  
On Line ◽  
Language Technologies

Modern day cloud native applications have become broadly representative of distributed systems in the wild. However, unlike traditional distributed system models with conceptually static designs, cloud-native systems emphasize dynamic scaling and on-line iteration (CI/CD). Cloud-native systems tend to be architected around a networked collection of distinct programs ("microservices") that can be added, removed, and updated in real-time. Typically, distinct containerized programs constitute individual microservices that then communicate among the larger distributed application through heavy-weight protocols. Common communication stacks exchange JSON or XML objects over HTTP, via TCP/TLS, and incur significant overhead, particularly when using small size message sizes. Additionally, interpreted/JIT/VM-based languages such as Javascript (NodeJS/Deno), Java, and Python are dominant in modern microservice programs. These language technologies, along with the high-overhead messaging, can impose superlinear cost increases (hardware demands) on scale-out, particularly towards hyperscale and/or with latency-sensitive workloads.

Language constructs for real-time distributed systems

1982 ◽  
Vol 7 (1) ◽  
pp. 11-20 ◽  
Author(s):  
D.M. Berry ◽  
C. Ghezzi ◽  
D. Mandrioli ◽  
F. Tisato
Keyword(s):  
Distributed Systems ◽  
Real Time ◽  
Language Constructs
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