A value set for documenting adverse reactions in electronic health records

被引：36

作者：

Goss, Foster R. ^{[1
]}

Lai, Kenneth H. ^{[2
]}

Topaz, Maxim ^{[3
,4
]}

Acker, Warren W. ^{[3
]}

Kowalski, Leigh ^{[3
]}

Plasek, Joseph M. ^{[2
,3
]}

Blumenthal, Kimberly G. ^{[5
,6
,7
]}

Seger, Diane L. ^{[8
]}

Slight, Sarah P. ^{[3
,4
,9
]}

Fung, Kin Wah ^{[10
]}

Chang, Frank Y. ^{[8
]}

Bates, David W. ^{[2
,4
,7
]}

Zhou, Li ^{[3
,7
,11
]}

机构：

[1] Univ Colorado, Dept Emergency Med, Aurora, CO USA

[2] Univ Utah, Sch Med, Dept Biomed Informat, Salt Lake City, UT USA

[3] Brigham & Womens Hosp, Div Gen Med & Primary Care, 75 Francis St, Boston, MA 02115 USA

[4] Univ Durham, Sch Med Pharm & Hlth, Div Pharm, Durham, England

[5] Massachusetts Gen Hosp, Div Rheumatol Allergy & Immunol, Boston, MA 02114 USA

[6] Massachusetts Gen Hosp, Dept Med, Med Practice Evaluat Ctr, Boston, MA 02114 USA

[7] Harvard Med Sch, Boston, MA USA

[8] Partners HealthCare Syst, Clin & Qual Anal, Boston, MA USA

[9] Newcastle Tyne Hosp NHS Fdn Trust, Newcastle Upon Tyne, Tyne & Wear, England

[10] Natl Lib Med, Bethesda, MD USA

[11] Partners HealthCare Syst, Clin Informat, Partners eCare, Boston, MA USA

来源：

JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION | 2018年 / 25卷 / 06期

基金：

美国医疗保健研究与质量局;

关键词：

drug-related side effects and adverse reactions; allergy and immunology; hypersensitivity; natural language processing; electronic health records; vocabulary; controlled; DRUG HYPERSENSITIVITY REACTIONS; EVENTS; METAANALYSIS; EXPERIENCE; SYSTEM; CARE;

D O I：

10.1093/jamia/ocx139

中图分类号：

TP [自动化技术、计算机技术];

学科分类号：

0812 ;

摘要：

Objective: To develop a comprehensive value set for documenting and encoding adverse reactions in the allergy module of an electronic health record. Materials and Methods: We analyzed 2 471 004 adverse reactions stored in Partners Healthcare's Enterprise-wide Allergy Repository (PEAR) of 2.7 million patients. Using the Medical Text Extraction, Reasoning, and Mapping System, we processed both structured and free-text reaction entries and mapped them to Systematized Nomenclature of Medicine -Clinical Terms. We calculated the frequencies of reaction concepts, including rare, severe, and hypersensitivity reactions. We compared PEAR concepts to a Federal Health Information Modeling and Standards value set and University of Nebraska Medical Center data, and then created an integrated value set. Results: We identified 787 reaction concepts in PEAR. Frequently reported reactions included: rash (14.0%), hives (8.2%), gastrointestinal irritation (5.5%), itching (3.2%), and anaphylaxis (2.5%). We identified an additional 320 concepts from Federal Health Information Modeling and Standards and the University of Nebraska Medical Center to resolve gaps due to missing and partial matches when comparing these external resources to PEAR. This yielded 1106 concepts in our final integrated value set. The presence of rare, severe, and hypersensitivity reactions was limited in both external datasets. Hypersensitivity reactions represented roughly 20% of the reactions within our data. Discussion: We developed a value set for encoding adverse reactions using a large dataset from one health system, enriched by reactions from 2 large external resources. This integrated value set includes clinically important severe and hypersensitivity reactions. Conclusion: This work contributes a value set, harmonized with existing data, to improve the consistency and accuracy of reaction documentation in electronic health records, providing the necessary building blocks for more intelligent clinical decision support for allergies and adverse reactions.

引用

页码：661 / 669

页数：9