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%到82.9%的美国人口接受了推荐的预防服务，甚至更多 具体地说，在19-35个月的美国儿童中，有70.7%到91.9%的人接受了推荐的 免疫接种(疾病控制和预防中心)。临床决策支持系统的应用 (CDS)可以帮助提高这些利率。Meta分析表明，CDS作为电子产品的一个组成部分， 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 在临床任务中决定CDS行为所需的知识。持续的规则维护是必要的 使CDS保持最新、有用并充分发挥其潜力。过时的规则可能会导致错过预防性警报 服务，甚至是由于过时的药物-药物相互作用警报导致患者死亡。目前，没有 免疫计划的公开可访问、可重复使用、通用和机器可解释的CDS规则。 从历史上看，CDS在大型学术机构中得到了成功的利用。在美国， 然而，小型诊所为大多数人提供医疗服务，其数量为 医生办公室就诊的次数大约是医院就诊的7.4倍。鉴于电子病历采用率迅速上升 在美国，在以办公室为基础的初级保健环境中，CDS使用率已达到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 规则对于维持CDS至关重要。CDS规则管理和维护已被确认为 在大型机构中具有挑战性。因此，我们预计CDS规则管理和维护将是一个 对于规模较小的初级保健做法，尤其是那些没有内部IT支持的做法来说，这是一个障碍。 本体是语义网的使能技术。本体论有可能改进 基于本体的CDS规则的互操作性、可重用性和共享性，这将通过以下方式减少重复工作 多个利益相关者。我们还建议允许初级保健提供者，特别是在没有- 内部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，有利于小规模初级保健实践。我们的努力将有助于更一致地 预防性服务，包括提高所服务的广大人口的免疫接种建议率 通过这些做法。我们建议(1)构建并验证上层CDS本体；(2)开发可移植的、 用于疾控中心推荐免疫的基于本体的可重用和机器可执行的CDS规则 时间表；(3)开发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)修订本体、CDS规则和 实施脚本。长期目标是通过以下方式实现跨平台的可互操作的电子病历 利用个人的免疫记录。从这项拟议调查中获得的经验将提供 这是我们长期目标的重要基础，并有助于解决CDS规则重用中的“大括号问题”。

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 Outdated rules can lead to missing alerts for preventive services or even to a patient’s death due to outdated drug-drug interaction alerts.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