A rules based algorithm to generate problem lists using emergency department medication reconciliation

• Published in: International journal of medical informatics (Shannon, Ireland) Vol. 94; pp. 117 - 122
• Main Authors: Joseph, Joshua W., Chiu, David T., Nathanson, Larry A., Horng, Steven
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2016
• Subjects: Aged; Algorithms; Clinical decision support; Databases, Factual; Electronic Health Records; Emergency medicine; Emergency Service, Hospital; Female; Heart Failure; Humans; Hypertension; Inpatients; Internal Medicine; Male; Meaningful use; Medication Errors - prevention & control; Medication Reconciliation; Middle Aged; Other; Quality assurance; Retrospective Studies; Quality assurance; Clinical decision support; Emergency medicine; Meaningful use; clinical decision support; emergency medicine; quality assurance; meaningful use
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2016.06.008

•We examined an algorithm to determine medical problems from medications.•We compared the algorithm to attending physicians and a standardized hospital list.•The algorithm was more sensitive for detecting all of the conditions.•The algorithm was less specific for conditions treated with more varied medications. To evaluate the sensitivity and specificity of a problem list automatically generated from the emergency department (ED) medication reconciliation. We performed a retrospective cohort study of patients admitted via the ED who also had a prior inpatient admission within the past year of an academic tertiary hospital. Our algorithm used the First Databank ontology to group medications into therapeutic classes, and applied a set of clinically derived rules to them to predict obstructive lung disease, hypertension, diabetes, congestive heart failure (CHF), and thromboembolism (TE) risk. This prediction was compared to problem lists in the last discharge summary in the electronic health record (EHR) as well as the emergency attending note. A total of 603 patients were enrolled from 03/29/2013–04/30/2013. The algorithm had superior sensitivity for all five conditions versus the attending problem list at the 99% confidence level (Obstructive Lung Disease 0.93 vs 0.47, Hypertension 0.93 vs 0.56, Diabetes 0.97 vs 0.73, TE Risk 0.82 vs 0.36, CHF 0.85 vs 0.38), while the attending problem list had superior specificity for both hypertension (0.76 vs 0.94) and CHF (0.87 vs 0.98). The algorithm had superior sensitivity for all conditions versus the EHR problem list (Obstructive Lung Disease 0.93 vs 0.34, Hypertension 0.93 vs 0.30, Diabetes 0.97 vs 0.67, TE Risk 0.82 vs 0.23, CHF 0.85 vs 0.32), while the EHR problem list also had superior specificity for detecting hypertension (0.76 vs 0.95) and CHF (0.87 vs 0.99). The algorithm was more sensitive than clinicians for all conditions, but less specific for conditions that are not treated with a specific class of medications. This suggests similar algorithms may help identify critical conditions, and facilitate thorough documentation, but further investigation, potentially adding alternate sources of information, may be needed to reliably detect more complex conditions.