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Background Early electronic identification of patients at the highest risk for heart failure (HF) readmission presents a challenge. Data needed to identify HF patients are in a variety of areas in the electronic medical record (EMR) and in different formats. Objective The purpose of this paper is to describe the development and data validation of a HF dashboard that monitors the overall metrics of outcomes and treatments of the veteran patient population with HF and enhancing the use of guideline-directed pharmacologic therapies. Methods We constructed a dashboard that included several data points: care assessment need score; ejection fraction (EF); medication concordance; laboratory tests; history of HF; and specified comorbidities based on International Classification of Disease (ICD), ninth and tenth codes. Data validation testing with user test scripts was utilized to ensure output accuracy of the dashboard. Nine providers and key senior management participated in data validation. Results A total of 43 medical records were reviewed and 66 HF dashboard data discrepancies were identified during development. Discrepancies identified included: generation of multiple EF values on a few patients, missing or incorrect ICD codes, laboratory omission, incorrect medication issue dates, patients incorrectly noted as nonconcordant for medications, and incorrect dates of last cardiology appointments. Continuous integration and builds identified defects—an important process of the verification and validation of biomedical software. Data validation and technical limitations are some challenges that were encountered during dashboard development. Evaluations by testers and their focused feedback contributed to the lessons learned from the challenges. Conclusion Continuous refinement with input from multiple levels of stakeholders is crucial to development of clinically useful dashboards. Extraction of all relevant information from EMRs, including the use of natural language processing, is crucial to development of dashboards that will help improve care of individual patients and populations.

If a quintessential metaphysical catechism were to be named, one of the major textual candidates would be H. Emilie Cady's Lessons in Truth-a basic for the Unity School of Christianity, a staple in its bookstores, and an often-cited work in its metaphysical communications. First published in 1894, the book features chapters that originated in a series of articles contributed to Unity publications from 1892 by Cady, a practicing physician. Exact records of how many copies have been published are not available, but the back cover of the 1967 edition offers one piece of evidence, announcing that the print order came to 60,000 copies per printing for many years and that this particular edition is the forty-fourth. Over thirty years later now, it is not unreasonable to estimate that some 3 million copies of the text have been printed. This work stands out not only because of its classical status but also because its slightly old-fashioned title Lessons in Truth conjures, in an especially marked way, the sense of belief in a fixed order of the universe that evocations of metaphysics initially convey. In this reified ontology there is a realm of absolute truth and reality, substantial and unchanging.

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