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

摘要 只有12.7%至82.9%的美国人口接受推荐的预防服务， 具体而言，70.7%至91.9%的19 - 35个月的美国儿童接受了建议的 免疫接种（疾病控制和预防中心，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作为电子产品的组成部分， 电子健康记录（EHR）是增加预防保健服务的有效手段。CDS的规则涉及 决定CDS在临床任务中的行为所需的知识。持续的规则维护对于 保持CDS的更新，有用，并充分发挥其潜力。过时的规则可能会导致预防性警报丢失 由于过时的药物相互作用警报，服务甚至患者死亡。目前没有 公共可访问的，可重复使用的，通用的，和机器可解释的免疫接种计划的CDS规则。 从历史上看，CDS已成功地用于大型学术机构。在美国， 然而，小型诊所为大多数人口提供医疗保健服务， 医生办公室访问量约为医院访问量的7.4倍。鉴于EHR采用率的快速增长， 在美国，在基于办公室的初级保健环境中，CDS使用率达到68.5%至100%， 这表明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规则管理和维护已被公认为 对大型机构的挑战。因此，我们预计CDS规则的管理和维护将是一个 这是小型初级保健实践的一个障碍，特别是那些没有内部IT支持的实践。 本体是语义网的使能技术。本体论有潜力改善 基于本体的CDS规则的互操作性、可重用性和可共享性，这将减少重复工作， 多个利益攸关方。我们还建议，使初级保健提供者，特别是在设置没有在- 提供IT支持，独立管理和维护CDS规则。调查的结果将是 从长远来看，这对小型初级保健实践有益。我们的努力将有助于更加一致地 预防服务，包括提高接受服务的广大人口的免疫接种推荐率 这些做法。我们建议（1）建立和验证上层CDS本体;（2）开发可移植的， 基于本体论的可重用、机器可执行的CDC推荐免疫规则 时间表;（3）制定CDS规则的实施脚本;（4）实施CDS规则并评估其 在模拟的初级保健环境中重复使用、使用和维护，以及（5）修改本体、CDS规则， 实现脚本。长期目标是通过以下方式实现跨平台无缝互操作的EHR 利用个人的免疫记录。从这项拟议的调查中获得的经验将提供 这是我们长期目标的关键基础，有助于解决CDS规则重用中的“花括号问题”。

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 Outdated rules can lead to missing alerts for preventive services or even to a patient’s death due to outdated drug-drug interaction alerts.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.