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: 10449239
• 负责人: Xia Jing
• 金额: $ 33.59万
• 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/10449239
• 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 Outdated rules can lead to missing alerts for preventive services or even to a patient’s death due to outdated drug-drug interaction alerts.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 只有 12.7% 至 82.9% 的美国人接受了推荐的预防服务，还有更多 具体而言，70.7% 至 91.9% 的 19-35 个月的美国儿童接受了推荐的 免疫接种（疾病控制与预防中心，CDC） 临床决策支持的利用。 (CDS) 可以帮助提高这些比率 荟萃分析表明，CDS 作为电子的一个组成部分。 健康记录 (EHR) 可有效提高预防性护理服务 CDS 的规则涉及以下内容。 决定 CDS 在临床任务中的行为所需的知识对于持续的规则维护是必要的。 保持 CDS 更新、有用并充分发挥其潜力，过时的规则可能会导致丢失预防性警报。 目前，还没有因过时的药物相互作用警报而导致服务中断甚至患者死亡的情况。 可公开访问、可重复使用、通用且机器可解释的免疫接种计划 CDS 规则。 从历史上看，CDS 已在美国的大型学术机构中得到成功应用。 然而，小型诊所为大多数人口提供医疗保健服务，其数量 鉴于 EHR 采用率迅速提高，医生办公室就诊次数约为医院就诊次数的 7.4 倍。 在美国，在办公室初级保健机构中 CDS 使用率已达到 68.5% 至 100%， 说明CDS目前在小型实践中发挥着重要作用，能够定期更新CDS。 规则对于维护CDS至关重要。CDS规则的管理和维护已被认为是重要的。 因此，我们预计 CDS 规则管理和维护将成为一个挑战。 小型初级保健实践面临障碍，尤其是那些没有内部 IT 支持的初级保健实践。 本体论是语义网的使能技术，具有改善语义网的潜力。 基于本体的 CDS 规则的互操作性、可重用性和可共享性，这将减少重复工作 我们还建议为初级保健提供者提供支持，特别是在没有内部设施的环境中。 内部 IT 支持，独立管理和维护 CDS 规则 调查的输出将是。 从长远来看，有利于小型初级保健实践，我们的努力将有助于实现更加一致。 预防服务，包括提高所服务的大量人口的免疫推荐率 通过这些实践，我们建议 (1) 构建并验证上层 CDS 本体；(2) 开发可移植的、 基于 CDC 推荐免疫本体的可重用且机器可执行的 CDS 规则 (3) 制定 CDS 规则的实施脚本； (4) 实施 CDS 规则并评估其 在模拟初级保健环境中重复使用、使用和维护，以及 (5) 修订本体论、CDS 规则，以及 长期目标是通过以下方式实现跨平台的无缝互操作 EHR。 从这项拟议的调查中获得的经验将提供使用免疫记录的个人。 这是我们长期目标的重要基础，有助于解决 CDS 规则重用中的“大括号问题”。