title: A method and knowledge base for automated inference of patient problems from structured data in an electronic medical record.
abstract: BACKGROUND
  Accurate knowledge of a patient's medical problems is critical for clinical decision making, quality measurement, research, billing and clinical decision support. Common structured sources of problem information include the patient problem list and billing data; however, these sources are often inaccurate or incomplete.
  
  
  OBJECTIVE
  To develop and validate methods of automatically inferring patient problems from clinical and billing data, and to provide a knowledge base for inferring problems.
  
  
  METHODS
  We identified 17 target conditions and designed and validated a set of rules for identifying patient problems based on medications, laboratory results, billing codes, and vital signs. A panel of physicians provided input on a preliminary set of rules. Based on this input, we tested candidate rules on a sample of 100,000 patient records to assess their performance compared to gold standard manual chart review. The physician panel selected a final rule for each condition, which was validated on an independent sample of 100,000 records to assess its accuracy.
  
  
  RESULTS
  Seventeen rules were developed for inferring patient problems. Analysis using a validation set of 100,000 randomly selected patients showed high sensitivity (range: 62.8-100.0%) and positive predictive value (range: 79.8-99.6%) for most rules. Overall, the inference rules performed better than using either the problem list or billing data alone.
  
  
  CONCLUSIONS
  We developed and validated a set of rules for inferring patient problems. These rules have a variety of applications, including clinical decision support, care improvement, augmentation of the problem list, and identification of patients for research cohorts.
authors: Department of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. awright5@partners.org
authors: Adam
authors: A
authors: Wright
authors: Justine
authors: J
authors: Pang
authors: Joshua C
authors: JC
authors: Feblowitz
authors: Francine L
authors: FL
authors: Maloney
authors: Allison R
authors: AR
authors: Wilcox
authors: Harley Z
authors: HZ
authors: Ramelson
authors: Louise I
authors: LI
authors: Schneider
authors: David W
authors: DW
authors: Bates
references: J Am Med Inform Assoc. 2010 Nov-Dec;17(6):675-80
references: 20962130
references: J Hosp Med. 2007 Jul;2(4):199-202
references: 17683098
references: J Biomed Inform. 2010 Dec;43(6):891-901
references: 20884377
references: N Engl J Med. 1968 Mar 21;278(12):652-7 concl
references: 5637250
references: BMC Med Inform Decis Mak. 2010 Feb 23;10:10
references: 20178586
references: AMIA Annu Symp Proc. 2008 Nov 06;:753-7
references: 18999284
references: Radiographics. 2009 Mar-Apr;29(2):331-43
references: 19168763
references: Ann Intern Med. 1973 May;78(5):751-62
references: 4711779
references: J Am Med Inform Assoc. 1999 May-Jun;6(3):245-51
references: 10332657
references: Crit Rev Med Inform. 1986;1(1):55-79
references: 3331579
references: J Am Med Inform Assoc. 2010 Sep-Oct;17(5):602-7
references: 20819871
references: Proc Annu Symp Comput Appl Med Care. 1994;:201-5
references: 7949920
references: J Am Med Inform Assoc. 2007 Jul-Aug;14(4):489-96
references: 17460131
references: Phys Ther. 1989 Jul;69(7):565-8
references: 2662227
references: Bioinformatics. 2010 May 1;26(9):1205-10
references: 20335276
references: AMIA Annu Symp Proc. 2008 Nov 06;:86-90
references: 18999215
references: MD Comput. 1991 Sep-Oct;8(5):291-9
references: 1749339
references: J Biomed Inform. 2006 Dec;39(6):589-99
references: 16359928
references: J Am Med Inform Assoc. 2010 Sep-Oct;17(5):568-74
references: 20819866
references: Circulation. 2010 Nov 16;122(20):2016-21
references: 21041692
references: AMIA Annu Symp Proc. 2009 Nov 14;2009:497-501
references: 20351906
references: AMIA Annu Symp Proc. 2005;:106-10
references: 16779011
references: Am J Manag Care. 2002 Jan;8(1):37-43
references: 11814171
references: N Engl J Med. 1971 Jan 7;284(1):51-2
references: 5538590
references: J Gen Intern Med. 2005 Feb;20(2):143-7
references: 15836547
references: AMIA Annu Symp Proc. 2005;:1084
references: 16779371
references: J Am Med Inform Assoc. 2010 Sep-Oct;17(5):588-94
references: 20819869
references: AMIA Annu Symp Proc. 2007 Oct 11;:498-502
references: 18693886
references: Proc AMIA Symp. 2002;:106-10
references: 12463796
references: Int J Med Inform. 2003 Dec;72(1-3):17-28
references: 14644303
references: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
references: 11904577
references: Int J Med Inform. 2008 Sep;77(9):602-12
references: 18280787
references: Ann Intern Med. 1999 Jul 20;131(2):117-26
references: 10419428