title: Monitoring suicidal patients in primary care using electronic health records.
abstract: BACKGROUND
  Patients at risk for suicide often come into contact with primary care providers, many of whom use electronic health records (EHRs) for charting. It is not known, however, how often suicide ideation or attempts are documented in EHRs.
  
  
  METHODS
  We used retrospective analyses of de-identified EHR data from a distributed health network of primary care organizations to estimate the frequency of using diagnostic codes to record suicidal ideation and attempts. Data came from 3 sources: a clinician notes field processed using natural language processing; a suicidal ideation item on a patient-reported depression severity instrument (9-item Patient Health Questionnaire [PHQ-9]); and diagnostic codes from the EHR.
  
  
  RESULTS
  Only 3% of patients with an indication of suicidal ideation in the notes field had a corresponding International Classification of Diseases, 9th Revision (ICD-9), code (κ = 0.036). Agreement between an indication of suicidal ideation from item 9 of the PHQ-9 and an ICD-9 code was slightly higher (κ = 0.068). Suicide attempt indicated in the notes field was more likely to be recorded using an ICD-9 code (19%; κ = 0.18).
  
  
  CONCLUSIONS
  Few cases of suicidal ideation and attempt were documented in patients' EHRs using diagnostic codes. Increased documentation of suicidal ideation and behaviors in patients' EHRs may improve their monitoring in the health care system.
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA). heather.anderson@ucdenver.edu.
authors.forename: Heather D
authors.initials: HD
authors.lastname: Anderson
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: Wilson D
authors.initials: WD
authors.lastname: Pace
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: Elias
authors.initials: E
authors.lastname: Brandt
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Nielsen
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: Richard R
authors.initials: RR
authors.lastname: Allen
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: David R
authors.initials: DR
authors.lastname: West
authors.affiliation: From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D059020:Suicidal Ideation; D055815:Young Adult
keywords: Attempted; Electronic Health Records; Natural Language Processing; Suicidal Ideation; Suicide