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Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Preventive Healthcare

Background:

  • A cloud-based clinical decision support system (CDSS) was implemented to remotely provide evidence-based guideline reminders for preventive health.
  • The study compared reminders from a new cloud-based CDSS with an existing local CDSS using the same patient data.

Purpose of the Study:

  • To measure the agreement between preventive care reminders generated by a new cloud-based CDSS and an existing local CDSS.
  • To evaluate the potential of cloud-based CDSS for supporting healthcare providers.

Main Methods:

  • Electronic health record data from primary care visits were analyzed.
  • Agreement was calculated using Cohen's Kappa coefficient, adjusted for prevalence and bias.
  • Comparison involved 405 patient visits over a 3-month period.

Main Results:

  • The cloud-based CDSS generated 965 reminders, while the local CDSS generated 889 reminders.
  • Adjusted agreement varied by reminder, with substantial to almost perfect agreement observed for most.
  • Seven out of 11 reminders demonstrated almost perfect agreement (Kappa > 0.8).

Conclusions:

  • Preventive care reminders from disparate CDSS show substantial agreement.
  • Differences in rule logic and terminology mapping explain most discordance.
  • Cloud-based CDSS show promise for resource-limited settings, aiding knowledge management.