Development, validation, and application of a CDS ontology to facilitate CDS rules reuse, management, and maintenance in simulated primary care settings.

CDS 本体的开发、验证和应用，以促进模拟初级保健环境中 CDS 规则的重用、管理和维护。

• 批准号: 10034926
• 负责人: Xia Jing
• 金额: $ 33.55万
• 依托单位: CLEMSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10034926
• 关键词: Adopted; Adoption; Behavior; Centers for Disease Control and Prevention (U.S.); Cessation of life; Child; Clinical; Communicable Diseases; Development; Drug Interactions; Electronic Health Record; Evaluation; Extensible Markup Language; Foundations; Goals; Health; Hospitals; Immunization; Immunization Schedule; Individual; Inequality; Institution; Interdisciplinary Study; Investigation; Knowledge; Lead; Literature; Maintenance; Measures; Medicine; Meta-Analysis; Monitor; National Institute of Allergy and Infectious Disease; Occupations; Office Visits; Ontology; Output; Participant; Patients; Pharmaceutical Preparations; Phase; Physicians; Play; Population; Preventive care; Preventive service; Primary Health Care; Process; Recommendation; Records; Reporting; Resources; Role; Savings; Schedule; Site; South Carolina; System; Technology; Texas; Time; Underserved Population; United States; Update; Vaccine Research; Validation; Vendor; Virginia; Visit; aged; base; care providers; care systems; clinical decision support; computer based Semantic Analysis; experience; health care service; improved; interoperability; operation; portability; prevent; prevention service; primary care setting; skills; syntax; usability

Abstract Only 12.7% to 82.9% of the U.S. population receives recommended prevention services, and more specifically, between 70.7% to 91.9% of U.S. children aged 19-35 months receive recommended immunizations (Centers for Disease Control and Prevention, CDC). The utilization of clinical decision support (CDS) can help to increase these rates. Meta-analyses have shown that CDS, as a component of electronic health records (EHRs), is effective in increasing preventive care services. The rules for a CDS involve the knowledge needed to decide a CDS’s behavior in clinical tasks. Continuous rule maintenance is necessary to keep a CDS updated, useful, and at its full potential. Outdated rules can lead to missing alerts for preventive services or even to a patient’s death due to outdated drug-drug interaction alerts. Currently, there are no publicly accessible, reusable, generic, and machine-interpretable CDS rules for immunization schedules. Historically, CDS has been utilized successfully in large academic institutions. In the United States, however, small practices provide healthcare services to a majority of the population, with the volume of physician office visits at about 7.4 times that of hospital visits. In view of rapidly increasing EHR adoption rates in the United States, CDS usage rates have reached 68.5% to 100% in office-based primary care settings, indicating that CDS currently plays an important role in small practices. To be able to regularly update CDS rules is critical to maintaining a CDS. CDS rule management and maintenance have been recognized as challenging in large institutions. Thus, we anticipate that CDS rule management and maintenance will be an obstacle for smaller primary care practices, especially those without in-house IT support. Ontology is the enabling technology of the Semantic Web. Ontology has the potential to improve the interoperability, reusability, and sharability of ontology-based CDS rules, which will reduce duplicate efforts by multiple stakeholders. We also propose to enable primary care providers, especially in settings without in- house IT support, to manage and maintain CDS rules independently. The output of the investigation will be beneficial to small primary care practices in the long term. Our efforts will contribute to more consistent preventive services, including improved immunization recommendation rates for the large population served by these practices. We propose to (1) build and validate an upper-level CDS ontology; (2) develop portable, reusable, and machine-executable CDS rules based on ontology for CDC-recommended immunization schedules; (3) develop implementation scripts for CDS rules; (4) implement CDS rules and evaluate their reuse, use, and maintenance in simulated primary care settings, and (5) revise ontology, CDS rules, and implementation scripts. The long-term goal is to achieve interoperable EHR across platforms seamlessly by utilizing individuals’ immunization records. The experience gained from this proposed investigation will provide a critical foundation for our long-term goal and help to solve “curly braces problem” in the reuse of CDS rules.

抽象的 美国只有12.7％至82.9％的人接受建议的预防服务，更多 具体而言，建议接受建议 免疫接种（疾病控制与预防中心，CDC）。利用临床决策支持 （CD）可以帮助提高这些费率。荟萃分析表明，CD作为电子的组成部分 健康记录（EHR）可有效增加预防保健服务。 CD的规则涉及 确定CD在临床任务中的行为所需的知识。连续规则维护是必要的 保持CD的更新，有用且具有全部潜力。过时的规则可能导致预防性缺失警报 由于过时的药物互动警报而导致患者死亡的服务。目前，没有 公开访问，可重复使用，通用和机器解释的CDS规则，用于免疫计划。 从历史上看，CD已成功地用于大型学术机构。在美国， 但是，小型实践为大多数人口提供医疗服务，数量 物理办公室的访问约为医院探访的7.4倍。鉴于EHR采用率迅速提高 在美国，在基于办公室的初级保健环境中，CDS的使用率已达到68.5％至100％， 表明CD当前在小型实践中起着重要作用。能够定期更新CD 规则对于维护CD至关重要。 CDS规则管理和维护已被认为是 在大型机构中具有挑战性。这是，我们预计CDS规则管理和维护将是 小型初级保健实践的障碍，尤其是那些没有内部IT支持的障碍。 本体论是语义网络的促成技术。本体论有可能改善 基于本体的CDS规则的互操作性，可重用性和可共享性，这将减少重复的努力 多个利益相关者。我们还建议启用初级保健提供者，尤其是在没有内置的情况下 托管IT支持，以独立管理和维护CDS规则。调查的输出将是 从长远来看，对小型初级保健实践有益。我们的努力将有助于更加一致 预防服务，包括改善所服务人群的免疫建议率 通过这些实践。我们建议（1）构建和验证高级CD本体论； （2）开发便携式， 可重复使用的，可重复使用的基于CDC推荐免疫本体的CDS规则 时间表； （3）用于CDS规则的开发实施脚本； （4）实施CDS规则并评估他们的 在模拟的初级保健设置中重用，使用和维护，以及（5）修改本体论，CDS规则和 实现脚本。长期目标是通过跨平台互操作的EHR无缝地实现 利用个人的免疫记录。从这项拟议的投资中获得的经验将提供 我们的长期目标的重要基础，并有助于解决CDS规则的重用中的“卷发括号问题”。