title: Approaches to recording drug allergies in electronic health records: qualitative study.
abstract: BACKGROUND
  Drug allergy represent an important subset of adverse drug reactions that is worthy of attention because many of these reactions are potentially preventable with use of computerised decision support systems. This is however dependent on the accurate and comprehensive recording of these reactions in the electronic health record. The objectives of this study were to understand approaches to the recording of drug allergies in electronic health record systems.
  
  
  METHODS
  We undertook a case study comprising of 21 in-depth interviews with a purposefully selected group of primary and secondary care clinicians, academics, and members of the informatics and drug regulatory communities, observations in four General Practices and an expert group discussion with 15 participants from the Allergy and Respiratory Expert Resource Group of the Royal College of General Practitioners.
  
  
  RESULTS
  There was widespread acceptance among healthcare professionals of the need for accurate recording of drug allergies and adverse drug reactions. Most drug reactions were however likely to go unreported to and/or unrecognised by healthcare professionals and, even when recognised and reported, not all reactions were accurately recorded. The process of recording these reactions was not standardised.
  
  
  CONCLUSIONS
  There is considerable variation in the way drug allergies are recorded in electronic health records. This limits the potential of computerised decision support systems to help alert clinicians to the risk of further reactions. Inaccurate recording of information may in some instances introduce new problems as patients are denied treatments that they are erroneously believed to be allergic to.
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Bernard
authors.initials: B
authors.lastname: Fernando
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Morrison
authors.affiliation: Centre for Health Informatics and Multiprofessional Education, University College London, London, United Kingdom.
authors.forename: Dipak
authors.initials: D
authors.lastname: Kalra
authors.affiliation: The School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Cresswell
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom; Harvard Medical School & Harkness Fellow in Health Care Policy and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D004342:Drug Hypersensitivity / Q000453:epidemiology*; D057286:Electronic Health Records; D006801:Humans
references.citation: BMJ. 2003 Nov 22;327(7425):1222-5
references.pmid: 14630763
references.citation: JAMA. 1995 Jul 5;274(1):29-34
references.pmid: 7791255
references.citation: Allergy. 1999 Sep;54(9):999-1003
references.pmid: 10505466
references.citation: PLoS One. 2009;4(2):e4439
references.pmid: 19209224
references.citation: Int J Med Inform. 2013 May;82(5):e73-86
references.pmid: 23146626
references.citation: BMJ. 2004 Jul 3;329(7456):15-9
references.pmid: 15231615
references.citation: Clin Exp Allergy. 2009 Jan;39(1):43-61
references.pmid: 19128352
references.citation: N Engl J Med. 2011 Nov 10;365(19):1756-8
references.pmid: 22070474
references.citation: N Engl J Med. 2012 Dec 27;367(26):2538-9
references.pmid: 23268669
references.citation: PLoS Med. 2011 Jan 18;8(1):e1000387
references.pmid: 21267058
references.citation: J Allergy Clin Immunol. 2008 May;121(5):1112-1117.e7
references.pmid: 18313132
references.citation: J Gen Intern Med. 2010 Jan;25(1):31-8
references.pmid: 19894081
references.citation: PLoS Med. 2009 Aug;6(8):e1000126
references.pmid: 19688038
references.citation: BMJ. 2004 May 15;328(7449):1197-9
references.pmid: 15142933
references.citation: Clin Exp Allergy. 2007 Nov;37(11):1586-93
references.pmid: 17883425
references.citation: BMJ. 2005 Nov 5;331(7524):1064-5
references.pmid: 16230312
references.citation: Lancet. 2000 Oct 7;356(9237):1255-9
references.pmid: 11072960
references.citation: Fam Pract. 2012 Feb;29(1):8-15
references.pmid: 21878467
references.citation: N Engl J Med. 2009 Apr 16;360(16):1628-38
references.pmid: 19321858
references.citation: BMC Med Res Methodol. 2011 Jun 27;11:100
references.pmid: 21707982