Building a Clinically Intelligent Risk Scoring Engine on OMOP CDM
In Greek mythology, Tyche was the goddess of fortune, chance, and prosperity. Depicted with a cornucopia of abundance and the wheel of fate, she governed the unpredictable forces that determined whether a city would flourish or fall. The ancient Greeks understood that outcomes are shaped by forces beyond individual control — health, circumstance, and probability. In the Parthenon pantheon, Tyche presides over population risk scoring: the quantification of clinical probability, the stratification of patients by the likelihood of outcomes they cannot fully control, and the transformation of uncertainty into actionable intelligence.
We built a population risk scoring engine that runs 20 validated clinical risk calculators against any OMOP CDM dataset — then immediately realized the approach was wrong. This post covers what we built, why we tore it apart, and the v2 architecture that replaced "run everything on everyone" with cohort-scoped, recommendation-driven clinical risk analysis.