Using a Healthcare Process Modeling Approach to Understand Electronic Health Records-based Pressure Injury Data and to Support Development of a Standardized Pressure Injury Phenotyping Pipeline.

The complexity of health care processes present significant challenges for using Electronic Health Records (EHR) data to build high fidelity phenotypes. This study leverages a healthcare process modeling (HPM) approach to enable understanding of EHR-based pressure injury (PrI) data patterns needed for building a standardized PrI phenotyping pipeline. The PrI HPM was developed and validated using mixed methods, including exploratory sequential design, through interdisciplinary collaboration among clinical experts, data scientists, database analysts, and informaticians. zThe qualitative analysis identified the dynamics between PrI care and the associated clinical documentation processes. The quantitative analysis identified inherent challenges and limitations of the PrI data. The PrI HPM includes three moderating factors: system configuration, hospital policy, and nurse's individual workflow. We further incorporated the HPM into the PrI phenotype development process to address phenotyping challenges. Moreover, we suggested a set of standardizable recommendations to address PrI phenotyping challenges.