title: Structured assessment for prospective identification of safety signals in electronic medical records: evaluation in the health improvement network.
abstract: BACKGROUND
  Pharmacovigilance signal detection largely relies on individual case reports, but longitudinal health data are being explored as complementary information sources. Research to date has focused on the ability of epidemiological methods to distinguish established adverse drug reactions (ADRs) from unrelated adverse events.
  
  
  OBJECTIVE
  The aim of this study was to evaluate a process for structured clinical and epidemiological assessment of temporally associated drugs and medical events in electronic medical records.
  
  
  METHODS
  Pairs of drugs and medical events were selected for review on the basis of their temporal association according to a calibrated self-controlled cohort analysis in The Health Improvement Network. Six assessors trained in pharmacovigilance and/or epidemiology evaluated seven drugs each, with up to 20 medical events per drug. A pre-specified questionnaire considered aspects related to the nature of the temporal pattern, demographic features of the cohort, concomitant medicines, earlier signs and symptoms, and possible confounding by underlying disease. This informed a classification of drug-event pairs as known ADRs, meriting further evaluation, or dismissed.
  
  
  RESULTS
  The number of temporally associated medical events per drug ranged from 11 to 307 (median 50) for the 42 selected drugs. Out of the 509 relevant drug-event combinations subjected to the assessment, 127 (25 %) were classified as known ADRs. Ninety-one (24 %) of the remaining pairs were classified as potential signals meriting further evaluation and 291 (76 %) were dismissed. Suggestive temporal patterns and lack of clear alternative explanations were the most common reasons that drug-event pairs were classified as meriting further evaluation. Earlier signs and symptoms and confounding by the underlying disease were the most common reasons that drug-event pairs were dismissed.
  
  
  CONCLUSIONS
  Exploratory analysis of electronic medical records can detect important potential safety signals. However, effective signal detection requires that statistical signal detection be combined with clinical and epidemiological review to achieve an acceptable false positive rate.
authors.affiliation: Uppsala Monitoring Centre, WHO Collaborating Centre for International Drug Monitoring, Box 1051, SE-75140, Uppsala, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Cederholm
authors.forename: G
authors.initials: G
authors.lastname: Hill
authors.forename: A
authors.initials: A
authors.lastname: Asiimwe
authors.forename: A
authors.initials: A
authors.lastname: Bate
authors.forename: F
authors.initials: F
authors.lastname: Bhayat
authors.forename: G
authors.initials: G
authors.lastname: Persson Brobert
authors.forename: T
authors.initials: T
authors.lastname: Bergvall
authors.forename: D
authors.initials: D
authors.lastname: Ansell
authors.forename: K
authors.initials: K
authors.lastname: Star
authors.forename: G N
authors.initials: GN
authors.lastname: Norén
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D060735:Pharmacovigilance; D011446:Prospective Studies; D011795:Surveys and Questionnaires