{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T10:49:07Z","timestamp":1774522147099,"version":"3.50.1"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"DOI":"10.13039\/100000133","name":"AHRQ","doi-asserted-by":"crossref","award":["HS26849\u201301"],"award-info":[{"award-number":["HS26849\u201301"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools.<\/jats:p><jats:p>\n          Methods\u2003We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS.<\/jats:p><jats:p>\n          Results\u2003We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21\/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9\u201311.2%), low exclusion (0\u20130.1%), and missing patient-specific context (up to 65.6%), leading to data in 2\/4 use cases being insufficient for accurate alerting.<\/jats:p><jats:p>\n          Discussion\u2003Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases.<\/jats:p><jats:p>\n          Conclusion\u2003Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences.<\/jats:p>","DOI":"10.1055\/s-0041-1732401","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T22:30:24Z","timestamp":1628116224000},"page":"710-720","source":"Crossref","is-referenced-by-count":13,"title":["Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis"],"prefix":"10.1055","volume":"12","author":[{"given":"David A.","family":"Dorr","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States"}]},{"given":"Christopher","family":"D'Autremont","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States"}]},{"given":"Christie","family":"Pizzimenti","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States"}]},{"given":"Nicole","family":"Weiskopf","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States"}]},{"given":"Robert","family":"Rope","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States"}]},{"given":"Steven","family":"Kassakian","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States"}]},{"given":"Joshua E.","family":"Richardson","sequence":"additional","affiliation":[{"name":"RTI International, Chicago, Illinois, United States"}]},{"given":"Rob","family":"McClure","sequence":"additional","affiliation":[{"name":"MD Partners, Lafayette, Colorado, United States"}]},{"given":"Floyd","family":"Eisenberg","sequence":"additional","affiliation":[{"name":"iParsimony, Washington, District of Columbia, United States"}]}],"member":"194","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"issue":"289","key":"ref1","first-page":"1","article-title":"Hypertension prevalence and control among adults: United States, 2015-2016","author":"C D Fryar","year":"2017","journal-title":"NCHS Data Brief"},{"key":"ref2","first-page":"CD007858","article-title":"Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in 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A mobile app to monitor hypertensive patients","volume":"7","author":"A Carrera","year":"2016","journal-title":"Appl Clin Inform"},{"issue":"05","key":"ref50","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1370\/afm.2121","article-title":"Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations","volume":"15","author":"B G Arndt","year":"2017","journal-title":"Ann Fam Med"},{"issue":"05","key":"ref51","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.mayocp.2018.08.036","article-title":"Optimization sprints: improving clinician satisfaction and teamwork by rapidly reducing electronic health record burden","volume":"94","author":"A Sieja","year":"2019","journal-title":"Mayo Clin Proc"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1732401.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T22:30:48Z","timestamp":1628116248000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1732401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":43,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2021,8,4]]},"published-print":{"date-parts":[[2021,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1732401","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}