ArticleBMC medical informatics and decision making2017
Utilizing patient data from the veterans administration electronic health record to support web-based clinical decision support: informatics challenges and issues from three clinical domains.
Article in BMC medical informatics and decision making, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Artificial intelligence approaches for phenotyping heart failure in U.S. Veterans Health Administration electronic health record.ESC heart failure · 2024Article
- User Experiences of Transitioning From a Homegrown Electronic Health Record to a Vendor-Based Product in the Department of Veterans Affairs: Qualitative Findings From a Mixed Methods Evaluation.JMIR formative research · 2024Article
- Natural Language Processing-Assisted Classification Models to Confirm Monoclonal Gammopathy of Undetermined Significance and Progression in Veterans' Electronic Health Records.JCO clinical cancer informatics · 2023Article
- Article
- Impact of Clopidogrel on Clinical Outcomes in Patients with Staphylococcus aureus Bacteremia: a National Retrospective Cohort Study.Antimicrobial agents and chemotherapy · 2022Article
- What You Need to Know Before Implementing a Clinical Research Data Warehouse: Comparative Review of Integrated Data Repositories in Health Care Institutions.JMIR formative research · 2020Review
- A minimum data set of user profile or electronic health record for chemical warfare victims' recommender system.Journal of family medicine and primary care · 2020Article
- sig2db: a Workflow for Processing Natural Language from Prescription Instructions for Clinical Data Warehouses.AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science · 2020Article
- Calculating maximum morphine equivalent daily dose from prescription directions for use in the electronic health record: a case report.JAMIA open · 2019Article
- Design Process and Utilization of a Novel Clinical Decision Support System for Neuropathic Pain in Primary Care: Mixed Methods Observational Study.JMIR medical informatics · 2019Article
- Advances in Sharing Multi-sourced Health Data on Decision Support Science 2016-2017.Yearbook of medical informatics · 2018Review
- Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers.Public health reports (Washington, D.C. : 1974)Article
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Authors and funding
8 authors.
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Abstract
backgroundThe US Veterans Administration (VA) has developed a robust and mature computational infrastructure in support of its electronic health record (EHR). Web technology offers a powerful set of tools for structuring clinical decision support (CDS) around clinical care. This paper describes informatics challenges and design issues that were confronted in the process of building three Web-based CDS systems in the context of the VA EHR.
methodsOver the course of several years, we implemented three Web-based CDS systems that extract patient data from the VA EHR environment to provide patient-specific CDS. These were 1) the VACS (Veterans Aging Cohort Study) Index Calculator which estimates prognosis for HIV+ patients, 2) Neuropath/CDS which assists in the medical management of patients with neuropathic pain, and 3) TRIM (Tool to Reduce Inappropriate Medications) which identifies potentially inappropriate medications in older adults and provides recommendations for improving the medication regimen.
resultsThe paper provides an overview of the VA EHR environment and discusses specific informatics issues/challenges that arose in the context of each of the three Web-based CDS systems. We discuss specific informatics methods and provide details of approaches that may be useful within this setting.
conclusionsInformatics issues and challenges relating to data access and data availability arose because of the particular architecture of the national VA infrastructure and the need to link to that infrastructure from local Web-based CDS systems. Idiosyncrasies of VA patient data, especially the medication data, also posed challenges. Other issues related to specific functional needs of individual CDS systems. The goal of this paper is to describe these issues so that our experience may serve as a useful foundation to assist others who wish to build such systems in the future.
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