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

被引：23

作者：

Groenhof, T. K. J. ^{[1
]}

Rittersma, Z. H. ^{[2
]}

Bots, M. L. ^{[1
]}

Brandjes, M. ^{[3
]}

Jacobs, J. J. L. ^{[3
]}

Grobbee, D. E. ^{[1
]}

van Solinge, W. W. ^{[4
]}

Visseren, F. L. J. ^{[5
]}

Haitjema, S. ^{[4
]}

Asselbergs, F. W. ^{[2
]}

de Jong, Pim A. ^{[9
]}

Verhaar, Marianne C. ^{[10
]}

Visseren, Frank L. J. ^{[11
]}

Asselbergs, Folkert W. ^{[6
,7
,8
,12
]}

van der Kaaij, Niels P. ^{[13
]}

Hofer, Imo E. ^{[14
]}

de Borst, Gert-Jan ^{[15
]}

Ruigrok, Ynte M. ^{[16
]}

Hollander, Monika ^{[17
]}

Dieleman, Stefan M. ^{[18
]}

Lely, A. Titia ^{[19
]}

Emmelot-Vonk, Marielle H. ^{[20
]}

Bots, Michiel L. ^{[21
]}

机构：

[1] Univ Utrecht, Julius Ctr Hlth Sci & Primary Care, Univ Med Ctr Utrecht, Utrecht, Netherlands

[2] Univ Utrecht, Dept Cardiol, Univ Med Ctr Utrecht, Div Heart & Lungs, Utrecht, Netherlands

[3] ORTEC BV, Zoetermeer, Netherlands

[4] Univ Utrecht, Dept Clin Chem & Haematol, Univ Med Ctr Utrecht, Utrecht, Netherlands

[5] Univ Utrecht, Dept Vasc Med, Univ Med Ctr Utrecht, Utrecht, Netherlands

[6] UCL, Fac Populat Hlth Sci, Inst Cardiovasc Sci, London, England

[7] UCL, Hlth Data Res UK, London, England

[8] UCL, Inst Hlth Informat, London, England

[9] Julius Ctr Hlth Sci & Primary Care, Radiol, Utrecht, Netherlands

[10] Julius Ctr Hlth Sci & Primary Care, Nephrol & Hypertens, Utrecht, Netherlands

[11] Julius Ctr Hlth Sci & Primary Care, Vasc Med, Utrecht, Netherlands

[12] Julius Ctr Hlth Sci & Primary Care, Cardiol, Utrecht, Netherlands

[13] Julius Ctr Hlth Sci & Primary Care, Cardiothorac Surg, Utrecht, Netherlands

[14] Julius Ctr Hlth Sci & Primary Care, Expt Cardiol, Utrecht, Netherlands

[15] Julius Ctr Hlth Sci & Primary Care, Vasc Surg, Utrecht, Netherlands

[16] Julius Ctr Hlth Sci & Primary Care, Neurol, Utrecht, Netherlands

[17] Julius Ctr Hlth Sci & Primary Care, Primary Care, Utrecht, Netherlands

[18] Julius Ctr Hlth Sci & Primary Care, Intens Care, Utrecht, Netherlands

[19] Julius Ctr Hlth Sci & Primary Care, Woman & Baby, Utrecht, Netherlands

[20] Julius Ctr Hlth Sci & Primary Care, Geriatr, Utrecht, Netherlands

[21] Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

来源：

NETHERLANDS HEART JOURNAL | 2019年 / 27卷 / 09期

关键词：

Computerised decision support system; Cardiovascular risk management; Adherence; Real-world data; Big data; Health information technology; CLINICAL-PRACTICE; DISEASE; PREVENTION;

D O I：

10.1007/s12471-019-01308-w

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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.

引用

页码：435 / 442

页数：8

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