title: Computer versus physician identification of gastrointestinal alarm features.
abstract: OBJECTIVE
  It is important for clinicians to inquire about "alarm features" as it may identify those at risk for organic disease and who require additional diagnostic workup. We developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that systematically collects patient gastrointestinal (GI) symptoms and alarm features, and then "translates" the information into a history of present illness (HPI). Our study's objective was to compare the number of alarms documented by physicians during usual care vs. that collected by AEGIS.
  
  
  METHODS
  We performed a cross-sectional study with a paired sample design among patients visiting adult GI clinics. Participants first received usual care by their physicians and then completed AEGIS. Each individual thus contributed both a physician-documented and computer-generated HPI. Blinded physician reviewers enumerated the positive alarm features (hematochezia, melena, hematemesis, unintentional weight loss, decreased appetite, and fevers) mentioned in each HPI. We compared the number of documented alarms within patient using the Wilcoxon signed-rank test.
  
  
  RESULTS
  Seventy-five patients had both physician and AEGIS HPIs. AEGIS identified more patients with positive alarm features compared to physicians (53% vs. 27%; p<.001). AEGIS also documented more positive alarms (median 1, interquartile range [IQR] 0-2) vs. physicians (median 0, IQR 0-1; p<.001). Moreover, clinicians documented only 30% of the positive alarms self-reported by patients through AEGIS.
  
  
  CONCLUSIONS
  Physicians documented less than one-third of red flags reported by patients through a computer algorithm. These data indicate that physicians may under report alarm features and that computerized "checklists" could complement standard HPIs to bolster clinical care.
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Almario
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Chey
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Sentia
authors.initials: S
authors.lastname: Iriana
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Dailey
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Robbins
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Anish V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Reid
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Whitman
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Garth
authors.initials: G
authors.lastname: Fuller
authors.affiliation: Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Bolus
authors.affiliation: UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA.
authors.forename: Buddy
authors.initials: B
authors.lastname: Dennis
authors.affiliation: UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA.
authors.forename: Rey
authors.initials: R
authors.lastname: Encarnacion
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Martinez
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Soares
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA.
authors.forename: Rushaba
authors.initials: R
authors.lastname: Modi
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kubomoto
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Gobind
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Bolus
authors.affiliation: Division of Digestive Diseases, UCLA, Los Angeles, CA, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Electronic address: Brennan.Spiegel@cshs.org.
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
mesh_terms: D000465:Algorithms; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D057286:Electronic Health Records / Q000458:organization & administration*; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D008487:Medical History Taking / Q000379:methods; D008824:Michigan; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D063189:Symptom Assessment / Q000379:methods; D014584:User-Computer Interface
keywords: Alarm features; Checklists; Patient-provider portal