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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

T. K. J. Groenhof, Z. H. Rittersma, M. L. Bots, M. Brandjes, J. J. L. Jacobs, D. E. Grobbee, W. W. van Solinge, F. L. J. Visseren, S. Haitjema, F. W. Asselbergs, Prof. Pim A. de Jong, Prof. Marianne C. Verhaar, Prof. Frank L. J. Visseren, Prof. Folkert W. Asselbergs, Dr. Niels P. van der Kaaij, Dr. Imo E. Höfer, Prof. Gert-Jan de Borst, Dr. Ynte M. Ruigrok, Dr. Monika Hollander, Dr. Stefan M. Dieleman, Dr. A. Titia Lely, Prof. Mariëlle H. Emmelot-Vonk & Prof. Michiel L. Bots

Published: 1 September 2019

Abstract

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.

What’s new?

  • Adherence to guidelines may improve if these are shown to patients and their healthcare providers in an electronic health record.
  • Clinical decision support tools that generate patient-specific assessments or recommendations may improve practitioner performance without additional utilisation of healthcare resources if data are collected in a standardised manner.
  • Guidance on scientific evaluation of eHealth tools is much needed to determine whether implementation cost-effectively improves patient outcomes.

Full Access Link: Netherlands Heart Journal