Scalable Clinical Decision Support for Individualized Cancer Risk Management

项目摘要/摘要 我们建议启用可扩展的临床决策支持(CDS)平台，帮助临床医生和患者 选择最适合每个人的癌症筛查策略。这种信用违约互换很重要 因为越来越多的证据支持根据每个人的癌症筛查决定个性化 独特的癌症风险。虽然这是一个非常理想的目标，但在人口规模上进行个性化筛查需要 对几种类型的癌症实施针对患者的风险评估。这是相当具有挑战性的 今天不堪重负的初级保健环境。我们建议的CDS平台通过以下方式应对这一挑战： 根据电子病历数据和患者报告数据，在人口层面自动进行风险分层； (Ii)遗传顾问对病人进行个案审查的优先次序；及。(Iii)自动传达风险及 与初级保健提供者及其患者一起筛选建议。 我们将CDS平台与Epic EHR集成，并在犹他大学医疗保健中心进行测试 社区诊所和亨斯迈癌症研究所。我们将评估CDS平台的通用性 在不同的机构(山间医疗)使用不同的EHR(Cerner)。最大限度地提高 对于建议的传播潜力癌症风险筛查平台，我们将扩展两个成熟的 开源CDS平台：OpenCDS和OpenInfoButton。这些平台是参考实现 美国电子健康记录认证所需的国际电子健康记录标准。我们还将获得软件 来自开源eHR联盟的认证，与其他人分享CDS平台和我们的经验 ITCR计划获奖者，在国内和国际癌症和信息学会议上展示CDS平台 会议；并通过技术专家小组与相关利益攸关方接触。 任何拥有经过认证的电子健康记录的医疗机构都将能够使用建议的CDS平台。因此，如果 如果成功，这项提议将对传播个性化癌症筛查产生重大影响 根据可获得的最佳证据进行实践。

Project Summary / Abstract We propose to enable a scalable clinical decision support (CDS) platform that helps clinicians and patients select cancer screening strategies that are best suited to each individual. This kind of CDS is important because increased evidence supports personalizing cancer screening decisions according to each individual's unique cancer risks. While a highly desired goal, individualizing screening at a population scale requires the implementation of patient-specific risk assessments for several types of cancer. This is quite challenging in today's overwhelmed primary care environment. Our proposed CDS platform addresses this challenge by (i) automating the risk stratification process at the population level based on EHR data and patient reported data; (ii) prioritizing patients for case review by genetic counselors; and (iii) automatically communicating risk and screening recommendations with primary care providers and their patients. We will integrate the CDS platform with the Epic EHR and test it at the University of Utah Health Care community clinics and the Huntsman Cancer Institute. We will assess the generalizability of the CDS platform with a different EHR (Cerner) at a different institution (Intermountain Healthcare). To maximize the dissemination potential for the proposed cancer risk screening platform, we will extend two well-established open source CDS platforms: OpenCDS and OpenInfobutton. These platforms are reference implementations of international EHR standards that are required for EHR certification in the US. We will also obtain software certification from the Open Source EHR Alliance, share the CDS platform and our experiences with other awardees in the ITCR Program, present the CDS platform at national and international cancer and informatics conferences; and engage with relevant stakeholders through a technical expert panel. Any healthcare organization with a certified EHR will be able to use the proposed CDS platform. Therefore, if successful, this proposal can have a significant impact on disseminating individualized cancer screening practices according to the best available evidence.