title: Clinical Decision Support for the Classification of Diabetic Retinopathy: A Comparison of Manual and Automated Results.
abstract: The management of diabetic retinopathy, a frequent ophthalmological manifestation of diabetes mellitus, consists of regular examinations and a standardized, manual classification of disease severity, which is used to recommend re-examination intervals. To evaluate the feasibility and safety of implementing automated, guideline-based diabetic retinopathy (DR) grading into clinical routine by applying established clinical decision support (CDS) technology. We compared manual with automated classification that was generated using medical documentation and an Arden server with a specific medical logic module. Of 7169 included eyes, 47% (n=3373) showed inter-method classification agreement, specifically 29.4% in mild DR, 38.3% in moderate DR, 27.6% in severe DR, and 65.7% in proliferative DR. We demonstrate that the implementation of a CDS system for automated disease severity classification in diabetic retinopathy is feasible but also that, due to the highly individual nature of medical documentation, certain important criteria for the used electronic health record system need to be met in order to achieve reliable results.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna.
authors.forename: Christoph
authors.initials: C
authors.lastname: Mitsch
authors.affiliation: Medexter Healthcare GmbH, Vienna.
authors.forename: Karsten
authors.initials: K
authors.lastname: Fehre
authors.affiliation: Department of Ophthalmology, Medical University of Vienna.
authors.forename: Sonja
authors.initials: S
authors.lastname: Prager
authors.affiliation: Department of Ophthalmology, Medical University of Vienna.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scholda
authors.affiliation: Department of Ophthalmology, Medical University of Vienna.
authors.forename: Katharina
authors.initials: K
authors.lastname: Kriechbaum
authors.affiliation: Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wrba
authors.affiliation: Department of Ophthalmology, Medical University of Vienna.
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt-Erfurth
mesh_terms: D020000:Decision Support Systems, Clinical; D003930:Diabetic Retinopathy / Q000145:classification* / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D006801:Humans; D009887:Ophthalmoscopy; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index