| Abstract |
Background and Objective
Early detection of cardiovascular (CV) disease or associated risk factors during childhood is of paramount importance, allowing for early treatment or lifestyle modifications, respectively.
The application of health screening programs in the general population is greatly supported by computer software that can manage electronic health records with integrated clinical decision support functionality. However, despite of the advantages of early CV disease and associated risk factors detection already during childhood, the research regarding CV disease screening and computer support systems development mainly focuses on adult CV disease.
The main objective of this study was to describe the development and validation of an electronic health record (EHR) system, with integrated computerized decision support system (CDSS) capabilities, specifically designed for supporting the needs of a pilot pediatric CV disease screening program applied on primary school students of a Mediterranean island. Secondary objectives include the development and validation of electronic health record individual elements which permit for a complete cardiovascular screening according to recent practice guidelines (including personal and family history, physical evaluation, electrocardiogram and phonocardiogram findings documentation and validation).
Methods
Evidence-based knowledge, national and international practice guidelines regarding sport preparticipation CV screening of children and young athletes has been used for the design of the designated EHR. A CDSS, capable for providing alerts for further cardiology evaluation need, has been incorporated into the EHR, based on normative anthropometric and electrocardiographic data as well as predefined positive history responses. The specifications of the software were based on the requirements and the needs of the pediatric CV disease screening program. For the design of the integrated information system, well-known software engineering techniques were applied, while usability and compliance to international standards of medical information systems, were of major importance during the development.
Results
We developed a designated EHR with integrated CDSS supporting pediatric CV disease screening, capable for documenting CV-related personal and family history responses, physical evaluation data (weight, height, blood pressure), allowing for entering electrocardiogram (ECG) measurements and for uploading of multimedia files (including ECG images and digital phonocardiogram audio files). The EHR incorporates clinical calculators and referral alerts for the presence (and degree) of adiposity, hypertension, ECG abnormalities and positive history responses indicative of high CV disease risk. In a preliminary EHR validation, performed by entering data from 53 previously available paper-based health records, the EHR was proven to be fully functional.
Conclusions
The pediatric cardiology EHR with CDSS features which we developed might serve as a model for EHR for primary health care purposes, capable to document and early detect CV disease and associated risk factors in pediatric populations. . It can be easily adapted to the priorities and methodology of any similar CV screening program applied to school age children, while it can serve as a model for EHR with CDSS supporting further pediatric health screening priorities.
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