Utilizing patient data from the veterans administration electronic health record to support web-based clinical decision support: informatics challenges and issues from three clinical domains
| Autor: | Terri R. Fried, Forrest L. Levin, Nallakkandi Rajeevan, Cynthia Brandt, Perry L. Miller, Peter Charpentier, Kristina M. Niehoff, Amy C. Justice |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Health Informatics
Context (language use) lcsh:Computer applications to medicine. Medical informatics Health informatics Clinical decision support system law.invention 03 medical and health sciences 0302 clinical medicine Health Administration Informatics law Correspondence Electronic Health Records Humans Web application Medicine 030212 general & internal medicine business.industry 030503 health policy & services Health Policy Electronic health records systems Clinical decision support Decision Support Systems Clinical Data science United States Computer Science Applications United States Department of Veterans Affairs Data access Calculator Informatics lcsh:R858-859.7 Biomedical informatics 0305 other medical science business |
| Zdroj: | BMC Medical Informatics and Decision Making, Vol 17, Iss 1, Pp 1-9 (2017) BMC Medical Informatics and Decision Making |
| ISSN: | 1472-6947 |
| DOI: | 10.1186/s12911-017-0501-x |
| Popis: | Background The US Veterans Administration (VA) has developed a robust and mature computational infrastructure in support of its electronic health record (EHR). Web technology offers a powerful set of tools for structuring clinical decision support (CDS) around clinical care. This paper describes informatics challenges and design issues that were confronted in the process of building three Web-based CDS systems in the context of the VA EHR. Methods Over the course of several years, we implemented three Web-based CDS systems that extract patient data from the VA EHR environment to provide patient-specific CDS. These were 1) the VACS (Veterans Aging Cohort Study) Index Calculator which estimates prognosis for HIV+ patients, 2) Neuropath/CDS which assists in the medical management of patients with neuropathic pain, and 3) TRIM (Tool to Reduce Inappropriate Medications) which identifies potentially inappropriate medications in older adults and provides recommendations for improving the medication regimen. Results The paper provides an overview of the VA EHR environment and discusses specific informatics issues/challenges that arose in the context of each of the three Web-based CDS systems. We discuss specific informatics methods and provide details of approaches that may be useful within this setting. Conclusions Informatics issues and challenges relating to data access and data availability arose because of the particular architecture of the national VA infrastructure and the need to link to that infrastructure from local Web-based CDS systems. Idiosyncrasies of VA patient data, especially the medication data, also posed challenges. Other issues related to specific functional needs of individual CDS systems. The goal of this paper is to describe these issues so that our experience may serve as a useful foundation to assist others who wish to build such systems in the future. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|