{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T03:43:38Z","timestamp":1770349418388,"version":"3.49.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2017,7,20]],"date-time":"2017-07-20T00:00:00Z","timestamp":1500508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive\n              and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["K23DK097187"],"award-info":[{"award-number":["K23DK097187"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Objective<\/jats:title>\n                  <jats:p>Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient\u2019s summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture\u2013based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocx065","type":"journal-article","created":{"date-parts":[[2017,6,19]],"date-time":"2017-06-19T19:16:52Z","timestamp":1497899812000},"page":"1111-1115","source":"Crossref","is-referenced-by-count":18,"title":["Implementation of a scalable, web-based, automated clinical decision support\n          risk-prediction tool for chronic kidney disease using C-CDA and application programming\n          interfaces"],"prefix":"10.1093","volume":"24","author":[{"given":"Lipika","family":"Samal","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}]},{"given":"John D","family":"D\u2019Amore","sequence":"additional","affiliation":[{"name":"Diameter Health Inc, Newton, MA, USA"},{"name":"Boston University, Boston, MA, USA"}]},{"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Partners HealthCare System, Boston, MA, USA"}]},{"given":"Adam","family":"Wright","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}]}],"member":"286","published-online":{"date-parts":[[2017,7,20]]},"reference":[{"issue":"2","key":"2020110612453238900_ocx065-B1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1197\/jamia.M2334","article-title":"A roadmap for national action on clinical decision\n            support","volume":"14","author":"Osheroff","year":"2007","journal-title":"J Am Med Inform\n            Assoc."},{"issue":"4","key":"2020110612453238900_ocx065-B2","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jbi.2011.03.008","article-title":"Summarization of clinical information: a conceptual\n          model","volume":"44","author":"Feblowitz","year":"2011","journal-title":"J Biomed\n            Inform."},{"key":"2020110612453238900_ocx065-B3","unstructured":"Cardiovascular Disease (10-year risk). https:\/\/www.framinghamheartstudy.org\/risk-functions\/cardiovascular-disease\/10-year-risk.php.\n            Accessed July 6, 2017."},{"key":"2020110612453238900_ocx065-B4","unstructured":"Breast Cancer Risk Assessment Tool.\n            https:\/\/www.cancer.gov\/bcrisktool\/. 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