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Feasibility of automatic evaluation of clinical rules in general practice.

Opondo, D., Visscher, S., Eslami, S., Medlock, S., Verheij, R., Korevaar, J.C., Abu-Hanna, A. Feasibility of automatic evaluation of clinical rules in general practice. International Journal of Medical Informatics: 2017, 100(4), 90-94
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Purpose
To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluationof quality of care in general practice.

Methods
We assessed 81 clinical rules (CRs) adapted from a subset of Assessing Care of Vulnerable Elders(ACOVE) clinical rules, against Dutch College of General Practitioners (NHG) data model. Each CR wasanalyzed using the Logical Elements RuleMethod: (LERM). LERM is a stepwise method of assessing and formalizing clinical rules for decisionsupport. Clinical rules that satisfied the criteria outlined in the LERM method were judged to be imple-mentable in automatic evaluation in general practice.

Results
Thirty-three out of 81 (40.7%) Dutch-translated ACOVE clinical rules can be automatically eval-uated in electronic medical record systems. Seven out of 7 CRs (100%) in the domain of diabetes canbe automatically evaluated, 9/17 (52.9%) in medication use, 5/10 (50%) in depression care, 3/6 (50%) innutrition care, 6/13 (46.1%) in dementia care, 1/6 (16.6%) in end of life care, 2/13 (15.3%) in continuityof care, and 0/9 (0%) in the fall-related care. Lack of documentation of care activities between primaryand secondary health facilities and ambiguous formulation of clinical rules were the main reasons for theinability to automate the clinical rules.

Conclusion
Approximately two-fifths of the primary care Dutch ACOVE-based clinical rules can be auto-matically evaluated. Clear definition of clinical rules, improved GP database design and electronic linkageof primary and secondary healthcare facilities can improve prospects of automatic assessment of qual-ity of care. These findings are relevant especially because the Netherlands has very high automation ofprimary care. (aut. ref.)