Appl Clin Inform 2021; 12(04): 710-720
DOI: 10.1055/s-0041-1732401
Research Article

Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis

David A. Dorr
1  Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Christopher D'Autremont
1  Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Christie Pizzimenti
1  Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Nicole Weiskopf
1  Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Robert Rope
1  Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Steven Kassakian
1  Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Joshua E. Richardson
2  RTI International, Chicago, Illinois, United States
,
Rob McClure
3  MD Partners, Lafayette, Colorado, United States
,
Floyd Eisenberg
4  iParsimony, Washington, District of Columbia, United States
› Author Affiliations
Funding This work was supported by AHRQ grant U18 HS26849–01.

Abstract

Objective This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools.

Methods We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS.

Results We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9–11.2%), low exclusion (0–0.1%), and missing patient-specific context (up to 65.6%), leading to data in 2/4 use cases being insufficient for accurate alerting.

Discussion Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases.

Conclusion Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences.

Protection of Human and Animal Subjects

Human and animal subjects were not included in this project. This work was approved by the Oregon Health and Science University Institutional Review Board.


Supplementary Material



Publication History

Received: 15 January 2021

Accepted: 04 June 2021

Publication Date:
04 August 2021 (online)

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