Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis
| Autor: | Christopher D'Autremont, Joshua E. Richardson, Steven Z. Kassakian, Rob McClure, Robert Rope, Nicole G. Weiskopf, Floyd Eisenberg, David A. Dorr, Christie Pizzimenti |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry Psychological intervention MEDLINE Health Informatics Context (language use) Guideline Decision Support Systems Clinical Clinical decision support system Computer Science Applications Health Information Management Data quality Health care Hypertension medicine Electronic Health Records Humans Intensive care medicine business Adverse effect Delivery of Health Care Software |
| Zdroj: | Appl Clin Inform |
| Popis: | Objective This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools. Methods We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS. Results We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9–11.2%), low exclusion (0–0.1%), and missing patient-specific context (up to 65.6%), leading to data in 2/4 use cases being insufficient for accurate alerting. Discussion Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases. Conclusion Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences. |
| Databáze: | OpenAIRE |
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