title: Using the electronic medical record to identify community-acquired pneumonia: toward a replicable automated strategy.
abstract: BACKGROUND
  Timely information about disease severity can be central to the detection and management of outbreaks of acute respiratory infections (ARI), including influenza. We asked if two resources: 1) free text, and 2) structured data from an electronic medical record (EMR) could complement each other to identify patients with pneumonia, an ARI severity landmark.
  
  
  METHODS
  A manual EMR review of 2747 outpatient ARI visits with associated chest imaging identified x-ray reports that could support the diagnosis of pneumonia (kappa score  = 0.88 (95% CI 0.82∶0.93)), along with attendant cases with Possible Pneumonia (adds either cough, sputum, fever/chills/night sweats, dyspnea or pleuritic chest pain) or with Pneumonia-in-Plan (adds pneumonia stated as a likely diagnosis by the provider). The x-ray reports served as a reference to develop a text classifier using machine-learning software that did not require custom coding. To identify pneumonia cases, the classifier was combined with EMR-based structured data and with text analyses aimed at ARI symptoms in clinical notes.
  
  
  RESULTS
  370 reference cases with Possible Pneumonia and 250 with Pneumonia-in-Plan were identified. The x-ray report text classifier increased the positive predictive value of otherwise identical EMR-based case-detection algorithms by 20-70%, while retaining sensitivities of 58-75%. These performance gains were independent of the case definitions and of whether patients were admitted to the hospital or sent home. Text analyses seeking ARI symptoms in clinical notes did not add further value.
  
  
  CONCLUSIONS
  Specialized software development is not required for automated text analyses to help identify pneumonia patients. These results begin to map an efficient, replicable strategy through which EMR data can be used to stratify ARI severity.
authors: Department of Medicine, Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA. sdelisle@umaryland.edu
authors: Sylvain
authors: S
authors: DeLisle
authors: Bernard
authors: B
authors: Kim
authors: Janaki
authors: J
authors: Deepak
authors: Tariq
authors: T
authors: Siddiqui
authors: Adi
authors: A
authors: Gundlapalli
authors: Matthew
authors: M
authors: Samore
authors: Leonard
authors: L
authors: D'Avolio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology; D015203:Reproducibility of Results; D012984:Software; D055815:Young Adult
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