Abstract
Background Clinical decision support systems (CDSS) for cervical cancer prevention are generally
limited to identifying patients who are overdue for their next routine/next screening,
and they do not provide recommendations for follow-up of abnormal results. We previously
developed a CDSS to automatically provide follow-up recommendations based on the American
Society of Colposcopy and Cervical Pathology (ASCCP) guidelines for women with both
previously normal and abnormal test results leveraging information available in the
electronic medical record (EMR).
Objective Enhance the CDSS by improving its accuracy and incorporating changes to reflect the
latest revision of the guidelines.
Methods After making enhancements to the CDSS, we evaluated the performance of the clinical
recommendations on 393 patients selected through stratified sampling from a set of
3,704 patients in a nonclinical setting. We performed chart review of individual patient's
record to evaluate the performance of the system. An expert clinician assisted by
a resident manually reviewed the recommendation made by the system and verified whether
the recommendations were as per the ASCCP guidelines.
Results The recommendation accuracy of the enhanced CDSS improved to 93%, which is a substantial
improvement over the 84% reported previously. A detailed analysis of errors is presented
in this article. We fixed the errors identified in this evaluation that were amenable
to correction to further improve the accuracy of the system. The source code of the
updated CDSS is available at https://github.com/ohnlp/MayoNlpPapCdss.
Conclusion We made substantial enhancements to our earlier prototype CDSS with the updated ASCCP
guidelines and performed a thorough evaluation in a nonclinical setting to improve
the accuracy of the CDSS. The CDSS will be further refined as it is utilized in the
practice.
Keywords
clinical decision support system - ambulatory care information systems - testing and
evaluation of health information technology - electronic health records - knowledge
delivery - knowledge management
