title: Phenotyping for patient safety: algorithm development for electronic health record based automated adverse event and medical error detection in neonatal intensive care.
abstract: BACKGROUND
  Although electronic health records (EHRs) have the potential to provide a foundation for quality and safety algorithms, few studies have measured their impact on automated adverse event (AE) and medical error (ME) detection within the neonatal intensive care unit (NICU) environment.
  
  
  OBJECTIVE
  This paper presents two phenotyping AE and ME detection algorithms (ie, IV infiltrations, narcotic medication oversedation and dosing errors) and describes manual annotation of airway management and medication/fluid AEs from NICU EHRs.
  
  
  METHODS
  From 753 NICU patient EHRs from 2011, we developed two automatic AE/ME detection algorithms, and manually annotated 11 classes of AEs in 3263 clinical notes. Performance of the automatic AE/ME detection algorithms was compared to trigger tool and voluntary incident reporting results. AEs in clinical notes were double annotated and consensus achieved under neonatologist supervision. Sensitivity, positive predictive value (PPV), and specificity are reported.
  
  
  RESULTS
  Twelve severe IV infiltrates were detected. The algorithm identified one more infiltrate than the trigger tool and eight more than incident reporting. One narcotic oversedation was detected demonstrating 100% agreement with the trigger tool. Additionally, 17 narcotic medication MEs were detected, an increase of 16 cases over voluntary incident reporting.
  
  
  CONCLUSIONS
  Automated AE/ME detection algorithms provide higher sensitivity and PPV than currently used trigger tools or voluntary incident-reporting systems, including identification of potential dosing and frequency errors that current methods are unequipped to detect.
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Melton
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Lingren
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
authors.affiliation: Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Hall
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Haijun
authors.initials: H
authors.lastname: Zhai
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Yizhao
authors.initials: Y
authors.lastname: Ni
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Kaiser
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Stoutenborough
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Imre
authors.initials: I
authors.lastname: Solti
mesh_terms: D058109:Airway Management / Q000009:adverse effects*; D000465:Algorithms; D057286:Electronic Health Records; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000009:adverse effects*; D007363:Intensive Care Units, Neonatal; D019300:Medical Errors / Q000009:adverse effects* / Q000517:prevention & control; D008508:Medication Errors / Q000009:adverse effects; D061214:Patient Safety; D011237:Predictive Value of Tests; D012308:Risk Management; D012680:Sensitivity and Specificity
keywords: Electronic Health Record (EHR); Natural Language Processing (NLP); Neonatal Intensive Care Unit (NICU); automatic adverse event and medical error detection; patient safety; phenotyping