title: Identifying opportunities in EHR to improve the quality of antibiotic allergy data.
abstract: BACKGROUND
  Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics.
  
  
  METHODS
  Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed.
  
  
  RESULTS
  Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR.
  
  
  CONCLUSIONS
  Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients' records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated.
authors.affiliation: Clinical Instructor of Public Health, Nova Southeastern University College of Osteopathic Medicine, Master of Public Health Program DrJMoskow@gmail.com.
authors.forename: Jaclynn M
authors.initials: JM
authors.lastname: Moskow
authors.affiliation: Assistant Professor of Public Health, Nova Southeastern University College of Osteopathic Medicine, Master of Public Health Program, Fort Lauderdale, FL, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cook
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Master of Public Health Program, Fort Lauderdale, FL, USA.
authors.forename: Carisa
authors.initials: C
authors.lastname: Champion-Lippmann
authors.affiliation: Chief Medical Officer, Community Health of South Florida and Health Choice Network, Inc. Miami, FL, USA.
authors.forename: Saint Anthony
authors.initials: SA
authors.lastname: Amofah
authors.affiliation: Associate Professor of Pharmacy, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004282:Documentation / Q000592:standards; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000208:ethnology; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D012737:Sex Factors; D047090:beta-Lactams / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: antibiotic resistance; beta-lactam antibiotics; community health centers; drug allergy; electronic health record