Scalable Clinical Decision Support for Individualized Cancer Risk Management

项目概要/摘要 我们建议启用一个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CDS很重要 因为越来越多的证据支持根据每个人的 独特的癌症风险。虽然这是一个非常理想的目标，但在人群规模上进行个体化筛查需要 对几种类型的癌症进行患者特定风险评估。这是相当具有挑战性的， 如今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：（i） 基于EHR数据和患者报告的数据，在人群水平上自动化风险分层过程; (ii)由遗传咨询师对患者的病例审查进行优先排序;以及（iii）自动传达风险， 初级保健提供者及其患者的筛查建议。 我们将把CDS平台与Epic EHR整合在一起，并在犹他州卫生保健大学进行测试 社区诊所和亨茨曼癌症研究所。我们将评估CDS平台的普遍性 在不同的机构（Intermountain Healthcare）使用不同的EHR（Cerner）。最大化 为推广建议的癌症风险筛查平台，我们将扩展两个完善的 开源CDS平台：OpenCDS和OpenInfobutton。这些平台是参考实现 美国EHR认证所需的国际EHR标准。我们还将获得软件 通过开源EHR联盟的认证，与其他人分享CDS平台和我们的经验， ITCR计划的获奖者，在国家和国际癌症和信息学会议上展示CDS平台 通过技术专家小组与相关利益攸关方接触。 任何拥有EHR认证的医疗机构都可以使用CDS平台。因此如果 如果成功，这一建议将对传播个体化癌症筛查产生重大影响。 根据现有的最佳证据。

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.