The decision support system in the treatment of arterial hypertension — control of the data entry into the electronic chart

Background. One of the key problems of keeping records in medical information systems is the correctness of the data entry. Even the simplest decision support systems (DSS) can be highly useful regarding the reduction in the number of errors in entering data and recommendations.

The purpose of this study was to assess the effectiveness of the implementation of the simplest DSS, designed to minimize the number of input errors of the patient’s key characteristics and to implement a basic control for the recommendation section.

Design and methods. DSS was developed as a data analysis system of a medical information system that can perform functions directly integrating into a working medical information system. The study involved 7 cardiologists of the counseling and diagnostic center of the Almazov National Medical Research Centre (St Petersburg, Russia), who tested the established DSS for 10 weeks as part of their daily work on counseling patients with arterial hypertension. Altogether 1280 records were analyzed in the main group and 1060 in the control group. 

Results.In the group with notifications enabled, the total number of errors in the same section comprised 49,1 %, while 84,7 % of them were recorded during the first week of using the system, and by the time of the visit only 8,7 % of the errors were registered. In the control group, the total number of errors was 63,7 %, while 42,2 % remained uncorrected. In the recommendation section, the number of errors was almost identical in both groups, 24 % in the group that worked in the “fixation” mode, and 25,5 % in the group with error notifications enabled. At the same time, in the latter one, at the end of the visit, 7 % errors remained uncorrected. In a detailed analysis of the data in the “physical examination” section, the largest number of missing data related to the anthropometric indicators, especially the waist circumference. When assessing the quality of input data, we found that the group with enabled notifications showed a progressive decrease in the number of errors and unfilled fields in the “physical examination” section.

Conclusion. The use of the simplest DSS in the outpatient admission of patients with arterial hypertension can significantly improve the quality of the input of structured data necessary for patient risk stratification. It also contributes to the patient’s safety in terms of the correctness of the medical prescriptions.

1. Blumenthal D, Glaser JP. Information technology comes to medicine. N Engl J Med. 2007;356(24):2527–2534. doi:10.1056/ nejmhpr066212

2. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363 (6):501–504. doi:10.1056/nejmp1006114

3. Montgomery AA, Tom F, Peters TJ, Christopher M, Sharp DJ. Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial. Br Med J. 2000;320(7236):686–90. doi:10.1136/bmj.320.7236.686

4. Anderson JA, Willson P, Peterson NJ, Murphy C, Kent TA. Prototype to practice developing and testing a clinical decision support system for secondary stroke prevention in a veterans healthcare facility. Comput Inform Nurs. 2010;28(6):353–363. doi:10.1097/ ncn.0b013e3181f69c5b

5. Garg AX, Adhikari NKJ, McDonald H. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. J Am Med Assoc. 2005;293 (10):1223–1238. doi:10.1001/jama.293.10.1223

6. Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med. 2003;348(25):2526–2534. doi:10.1056/ nejmsa020847