title: Structured vs. unstructured: factors affecting adverse drug reaction documentation in an EMR repository.
abstract: Adverse reactions to medications to which the patient was known to be intolerant are common. Electronic decision support can prevent them but only if history of adverse reactions to medications is recorded in structured format. We have conducted a retrospective study of 31,531 patients with adverse reactions to statins documented in the notes, as identified with natural language processing. The software identified statin adverse reactions with sensitivity of 86.5% and precision of 91.9%. Only 9020 of these patients had an adverse reaction to a statin recorded in structured format. In multivariable analysis the strongest predictor of structured documentation was utilization of EMR functionality that integrated the medication list with the structured medication adverse reaction repository (odds ratio 48.6, p < 0.0001). Integration of information flow between EMR modules can help improve documentation and potentially prevent adverse drug events.
authors.affiliation: Brigham and Women's Hospital, Inc., Boston, MA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Skentzos
authors.forename: Maria
authors.initials: M
authors.lastname: Shubina
authors.forename: Jorge
authors.initials: J
authors.lastname: Plutzky
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000465:Algorithms; D057286:Electronic Health Records; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D015999:Multivariate Analysis; D009323:Natural Language Processing; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012984:Software; D018511:Systems Integration
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors