A computerised decision support system for cardiovascular risk management ‘live’ in the electronic health record environment: development, validation and implementation—the Utrecht Cardiovascular Cohort Initiative

Purpose We set out to develop a real-time computerised decision support system (CDSS) embedded in the electronic health record (EHR) with information on risk factors, estimated risk, and guideline-based advice on treatment strategy in order to improve adherence to cardiovascular risk management (CVR...

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Vydané v:Netherlands heart journal Ročník 27; číslo 9; s. 435 - 442
Hlavní autori: Groenhof, T. K. J., Rittersma, Z. H., Bots, M. L., Brandjes, M., Jacobs, J. J. L., Grobbee, D. E., van Solinge, W. W., Visseren, F. L. J., Haitjema, S., Asselbergs, F. W.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Houten Bohn Stafleu van Loghum 01.09.2019
Springer Nature B.V
Predmet:
Accuracy
Cardiology
Clinical outcomes
Decision making
Decision support systems
Decision trees
Diabetes
Electronic health records
Infrastructure
Medical Education
Medicine
Medicine & Public Health
Mortality
Original
Original Article
Patients
Questionnaires
Risk assessment
Risk factors
Security clearances
Structured Query Language-SQL
User experience
User interface
Web portals
Adherence
Cardiovascular risk management
Computerised decision support system
Big data
Real-world data
Health information technology
ISSN:1568-5888, 1876-6250
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Popis
Shrnutí:Purpose We set out to develop a real-time computerised decision support system (CDSS) embedded in the electronic health record (EHR) with information on risk factors, estimated risk, and guideline-based advice on treatment strategy in order to improve adherence to cardiovascular risk management (CVRM) guidelines with the ultimate aim of improving patient healthcare. Methods We defined a project plan including the scope and requirements, infrastructure and interface, data quality and study population, validation and evaluation of the CDSS. Results In collaboration with clinicians, data scientists, epidemiologists, ICT architects, and user experience and interface designers we developed a CDSS that provides ‘live’ information on CVRM within the environment of the EHR. The CDSS provides information on cardiovascular risk factors (age, sex, medical and family history, smoking, blood pressure, lipids, kidney function, and glucose intolerance measurements), estimated 10-year cardiovascular risk, guideline-compliant suggestions for both pharmacological and non-pharmacological treatment to optimise risk factors, and an estimate on the change in 10-year risk of cardiovascular disease if treatment goals are adhered to. Our pilot study identified a number of issues that needed to be addressed, such as missing data, rules and regulations, privacy, and patient participation. Conclusion Development of a CDSS is complex and requires a multidisciplinary approach. We identified opportunities and challenges in our project developing a CDSS aimed at improving adherence to CVRM guidelines. The regulatory environment, including guidance on scientific evaluation, legislation, and privacy issues needs to evolve within this emerging field of eHealth.
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ISSN:1568-5888
1876-6250
DOI:10.1007/s12471-019-01308-w