title: Feasibility of automatic evaluation of clinical rules in general practice.
abstract: To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluation of quality of care in general practice.
  
  
  
  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 was analyzed using the Logical Elements Rule METHOD: (LERM). LERM is a stepwise method of assessing and formalizing clinical rules for decision support. Clinical rules that satisfied the criteria outlined in the LERM method were judged to be implementable in automatic evaluation in general practice.
  
  
  
  Thirty-three out of 81 (40.7%) Dutch-translated ACOVE clinical rules can be automatically evaluated in electronic medical record systems. Seven out of 7 CRs (100%) in the domain of diabetes can be automatically evaluated, 9/17 (52.9%) in medication use, 5/10 (50%) in depression care, 3/6 (50%) in nutrition care, 6/13 (46.1%) in dementia care, 1/6 (16.6%) in end of life care, 2/13 (15.3%) in continuity of care, and 0/9 (0%) in the fall-related care. Lack of documentation of care activities between primary and secondary health facilities and ambiguous formulation of clinical rules were the main reasons for the inability to automate the clinical rules.
  
  
  
  Approximately two-fifths of the primary care Dutch ACOVE-based clinical rules can be automatically evaluated. Clear definition of clinical rules, improved GP database design and electronic linkage of primary and secondary healthcare facilities can improve prospects of automatic assessment of quality of care. These findings are relevant especially because the Netherlands has very high automation of primary care.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZAmsterdam, The Netherlands. Electronic address: dedan.opondo@gmail.com.
authors.forename: Dedan
authors.initials: D
authors.lastname: Opondo
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO BOX 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Visscher
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZAmsterdam, The Netherlands; Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Saied
authors.initials: S
authors.lastname: Eslami
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZAmsterdam, The Netherlands.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Medlock
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO BOX 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Verheij
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO BOX 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: Joke C
authors.initials: JC
authors.lastname: Korevaar
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZAmsterdam, The Netherlands.
authors.forename: Ameen
authors.initials: A
authors.lastname: -Abu-Hanna
mesh_terms: D001331:Automation; D020000:Decision Support Systems, Clinical; D004282:Documentation; D005240:Feasibility Studies; D058006:General Practice / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic / Q000592:standards*; D012984:Software
keywords: Assessing Care of Vulnerable Elders (ACOVE); Clinical decision support systems; Clinical rules; Electronic health records; General practice; Vulnerable elders