title: Automating assessment of lifestyle counseling in electronic health records.
abstract: BACKGROUND
  Numerous population-based surveys indicate that overweight and obese patients can benefit from lifestyle counseling during routine clinical care.
  
  
  OBJECTIVE
  To determine if natural language processing (NLP) could be applied to information in the electronic health record (EHR) to automatically assess delivery of weight management-related counseling in clinical healthcare encounters.
  
  
  METHODS
  The MediClass system with NLP capabilities was used to identify weight-management counseling in EHRs. Knowledge for the NLP application was derived from the 5As framework for behavior counseling: Ask (evaluate weight and related disease), Advise at-risk patients to lose weight, Assess patients' readiness to change behavior, Assist through discussion of weight-loss methods and programs, and Arrange follow-up efforts including referral. Using samples of EHR data between January 1, 2007, and March 31, 2011, from two health systems, the accuracy of the MediClass processor for identifying these counseling elements was evaluated in postpartum visits of 600 women with gestational diabetes mellitus (GDM) compared to manual chart review as the gold standard. Data were analyzed in 2013.
  
  
  RESULTS
  Mean sensitivity and specificity for each of the 5As compared to the gold standard was at or above 85%, with the exception of sensitivity for Assist, which was 40% and 60% for each of the two health systems. The automated method identified many valid Assist cases not identified in the gold standard.
  
  
  CONCLUSIONS
  The MediClass processor has performance capability sufficiently similar to human abstractors to permit automated assessment of counseling for weight loss in postpartum encounter records.
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon. Electronic address: brian.hazlehurst@kpchr.org.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hazlehurst
authors.affiliation: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado.
authors.forename: William T
authors.initials: WT
authors.lastname: Donahoo
authors.affiliation: HealthPartners Institute for Education & Research, Minneapolis, Minnesota.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Sherwood
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kurtz
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado.
authors.forename: Stan
authors.initials: S
authors.lastname: Xu
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado.
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000328:Adult; D003376:Counseling / Q000458:organization & administration*; D016640:Diabetes, Gestational / Q000453:epidemiology; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D009323:Natural Language Processing; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D044469:Racial Groups; D012017:Referral and Consultation
references.citation: J Gen Intern Med. 2010 May;25(5):415-22
references.pmid: 20217268
references.citation: J Am Med Inform Assoc. 2005 Sep-Oct;12(5):517-29
references.pmid: 15905485
references.citation: J Eval Clin Pract. 2012 Aug;18(4):861-5
references.pmid: 21689215
references.citation: Acad Med. 2004 Feb;79(2):156-61
references.pmid: 14744717
references.citation: Stat Med. 1998 Apr 30;17(8):857-72
references.pmid: 9595616
references.citation: Soc Sci Med. 2006 May;62(10):2458-68
references.pmid: 16376006
references.citation: JAMA. 2012 Feb 1;307(5):491-7
references.pmid: 22253363
references.citation: J Clin Rheumatol. 2007 Feb;13(1):12-5
references.pmid: 17278942
references.citation: Prev Chronic Dis. 2012;9:E110
references.pmid: 22677160
references.citation: Am J Public Health. 2010 Jun;100(6):1047-52
references.pmid: 20395581
references.citation: N Engl J Med. 2002 Feb 21;346(8):591-602
references.pmid: 11856799
references.citation: Diabetes Care. 2012 Feb;35(2):334-41
references.pmid: 22275442
references.citation: Diabetes Care. 2008 May;31(5):899-904
references.pmid: 18223030
references.citation: Diabetes Care. 2002 Oct;25(10):1862-8
references.pmid: 12351492
references.citation: Ann Intern Med. 2003 Dec 2;139(11):930-2
references.pmid: 14644896
references.citation: JAMA. 1999 Oct 27;282(16):1576-8
references.pmid: 10546698
references.citation: Obes Res. 2001 Nov;9 Suppl 4:302S-311S
references.pmid: 11707558
references.citation: Med Care. 2007 Apr;45(4):322-9
references.pmid: 17496716
references.citation: J Comp Eff Res. 2012 Sep;1(5):373-6
references.pmid: 24236411
references.citation: Arch Fam Med. 2000 Jul;9(7):631-8
references.pmid: 10910311
references.citation: N Engl J Med. 2002 Feb 7;346(6):393-403
references.pmid: 11832527
references.citation: Am J Prev Med. 2005 Dec;29(5):434-9
references.pmid: 16376707
references.citation: Obes Res. 1998 Sep;6 Suppl 2:51S-209S
references.pmid: 9813653
references.citation: JAMA. 1999 Oct 27;282(16):1583-8
references.pmid: 10546701
references.citation: Diabetes Care. 2007 Jul;30 Suppl 2:S141-6
references.pmid: 17596462
references.citation: Diabetologia. 2011 Dec;54(12):3016-21
references.pmid: 22016046
references.citation: Health Promot Int. 2006 Sep;21(3):245-55
references.pmid: 16751630
references.citation: Prev Med. 2009 Dec;49(6):482-6
references.pmid: 19786045