Appl Clin Inform 2022; 13(04): 828-835
DOI: 10.1055/s-0042-1756367
Research Article

Integration of Risk Scores and Integration Capability in Electronic Patient Records

Ann-Kathrin Heider
1   Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
Harald Mang
2   Universitätsklinikum Erlangen, Erlangen, Germany
› Author Affiliations


Background Digital availability of patient data is continuously improving with the increasing implementation of electronic patient records in physician practices. The emergence of digital health data defines new fields of application for data analytics applications, which in turn offer extensive options of using data. Common areas of data analytics applications include decision support, administration, and fraud detection. Risk scores play an important role in compiling algorithms that underlay tools for decision support.

Objectives This study aims to identify the current state of risk score integration and integration capability in electronic patient records for cardiovascular disease and diabetes in German primary care practices.

Methods We developed an evaluation framework to determine the current state of risk score integration and future integration options for four cardiovascular disease risk scores (arriba, Pooled Cohort Equations, QRISK3, and Systematic Coronary Risk Evaluation) and two diabetes risk scores (Finnish Diabetes Risk Score and German Diabetes Risk Score). We then used this framework to evaluate the integration of risk scores in common practice software solutions by examining the software and inquiring the respective software contact person.

Results Our evaluation showed that the most widely integrated risk score is arriba, as recommended by German medical guidelines. Every software version in our sample provided either an interface to arriba or the option to implement one. Our assessment of integration capability revealed a more nuanced picture. Results on data availability were mixed. Each score contains at least one variable, which requires laboratory diagnostics. Our analysis of data standardization showed that only one score documented all variables in a standardized way.

Conclusion Our assessment revealed that the current state of risk score integration in physician practice software is rather low. Integration capability currently faces some obstacles. Future research should develop a comprehensive framework that considers the reasonable integration of risk scores into practice workflows, disease prevention programs, and the awareness of physicians and patients.


The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. rer. biol. hum.” by Ann-Kathrin Heider from the Friedrich-Alexander-Universität Erlangen-Nürnberg.

Protection of Human and Animal Subjects

Human and/or animal subjects were not included in the project.

Supplementary Material

Publication History

Received: 22 February 2022

Accepted: 13 July 2022

Article published online:
07 September 2022

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