System development
obstructive pulmonary disease (COPD)Congestive, CHF, heart failure, artery disease, infarction
BLOOD DISEASES, FIRES, CHF, HEART FAILURE, ARTERY DISEASE, INFARCTION
We developed and validated problem identification algorithms for 12 clinically significant heart, lung, and blood diseases:AsthmaAtrial fibrillationChronic obstructive pulmonary disease (COPD)Congestive heart failure (CHF)Coronary artery disease (CAD)HyperlipidemiaHypertensionMyocardial infarction (MI)Sickle cell anemiaSleep apneaStrokeTuberculosisThese algorithms used a combination of laboratory results, medications, encounter diagnosis codes, and procedures to identify patients who are likely to have one of these conditions, but who do not have a relevant problem list code on their problem list. The details of the algorithms are given in We then developed a CDS alert, which fires during a clinical encounter and suggests adding the potentially missing problem to the problem list. Screenshot of the IQ-MAPLE intervention, for CHF, at MGB.Each site used the same alerting logic and developed in-workflow CDS alerts to prompt users to add problems to the problem list. However, owing to differences in the clinical environments and EHRs at each site, they were free to tailor the presentation and workflow of the alert, following a standard framework for flexible EHR-based interventions.