Automated Dynamic Lists for Efficient Electronic Health Record Management

DESCRIPTION (provided by APPLICANT): Medical errors are recognized as the cause of numerous deaths, and even if some are difficult to avoid, many are preventable. Computerized physician order-entry systems with decision support have been proposed to reducethis risk of medication errors, but these systems rely on structured and coded information in the electronic health record (EHR). Unfortunately, a substantial proportion of the information available in the EHR is only mentioned in narrative clinical documents. Electronic lists of problems and allergies are available in most EHRs, but they require manual management by their users, to add new problems, modify existing ones, and the removal of the ones that are irrelevant. Consequently, these electronic listsare often incomplete, inaccurate, and out of date. Clinacuity, Inc. proposes to develop a new system to automatically extract structured and coded medical problems and allergies from clinical narrative text in the EHR of patients suffering from cancer. To establish the merit and feasibility of such a system, we will work on the following objectives: 1) create a reference standard for training and testing the information extraction application, a reference standard including a random sample of de-identified clinical narratives from patients treated at the Huntsman Cancer Institute Cancer Clinics (Salt Lake City, Utah), with problems and allergies annotated by domain experts; 2) develop a prototype to automatically extract medical problems and allergies, implementing a novel stepwise hybrid approach to maximize sensitivity first, and also enhance positive predictive value; and 3) test the prototype with the aforementioned reference standard, using a cross-validation approach for training and testing. Commercial application: The system Clinacuity proposes will not only help healthcare providers maintain complete and timely lists of problems and allergies, providing them with an efficient overview of a patient, but also help healthcare organizations attain meaningful use requirements. The proposed system has potential commercial applications in inpatient and outpatient settings, increasing the efficiency of busy healthcare providers by saving time, and aiding healthcare organizations in demonstrating meaningfuluse and obtaining Centers for Medicare and Medicaid Services incentive payments. Clinacuity will further extend the commercial potential of the system and it is output, using modular design principles allowing utilization of each module independently, andenhancing its local adaptability for easier deployment. PUBLIC HEALTH RELEVANCE PUBLIC HEALTH RELEVANCE: Medical errors cause numerous deaths, and even if some are difficult to avoid, many could be prevented. Computerized physician order-entrysystems with decision support have been proposed to reduce this risk of medication errors, but these systems rely on structured and coded information such as entries in electronic lists of problems and allergies. Such lists are available in most electronichealth records, but they require manual management and are often incomplete, inaccurate, and out of date. On the other hand, clinical text reports contain the majority of the patient information, including problems and allergies. The overall goal of thisproject is to develop a new system to automatically extract structured and coded medical problems and allergies from clinical narrative text in the electronic health record.