Assessing the accuracy of an inter-institutional automated patient-specific health problem list

BMC Medical Informatics and Decision Making

Research Article

Lise Poissant¹  Allen Huang²  Robyn Tamblyn³  Laurel Taylor⁴ 

[1] Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Qc, Canada;School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada;Department of Medicine, McGill University, Montreal, Quebec, Canada;Department of Medicine, McGill University, Montreal, Quebec, Canada;Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada;Department of Medicine, McGill University, Montreal, Quebec, Canada;Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada;

关键词: Therapeutic Indication;    Diagnostic Code;    Clinical Decision Support System;    Problem List;    Electronic Prescription;   

DOI  :  10.1186/1472-6947-10-10

 received in 2009-05-29, accepted in 2010-02-23,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundHealth problem lists are a key component of electronic health records and are instrumental in the development of decision-support systems that encourage best practices and optimal patient safety. Most health problem lists require initial clinical information to be entered manually and few integrate information across care providers and institutions. This study assesses the accuracy of a novel approach to create an inter-institutional automated health problem list in a computerized medical record (MOXXI) that integrates three sources of information for an individual patient: diagnostic codes from medical services claims from all treating physicians, therapeutic indications from electronic prescriptions, and single-indication drugs.MethodsData for this study were obtained from 121 general practitioners and all medical services provided for 22,248 of their patients. At the opening of a patient's file, all health problems detected through medical service utilization or single-indication drug use were flagged to the physician in the MOXXI system. Each new arising health problem were presented as 'potential' and physicians were prompted to specify if the health problem was valid (Y) or not (N) or if they preferred to reassess its validity at a later time.ResultsA total of 263,527 health problems, representing 891 unique problems, were identified for the group of 22,248 patients. Medical services claims contributed to the majority of problems identified (77%), followed by therapeutic indications from electronic prescriptions (14%), and single-indication drugs (9%). Physicians actively chose to assess 41.7% (n = 106,950) of health problems. Overall, 73% of the problems assessed were considered valid; 42% originated from medical service diagnostic codes, 11% from single indication drugs, and 47% from prescription indications. Twelve percent of problems identified through other treating physicians were considered valid compared to 28% identified through study physician claims.ConclusionAutomation of an inter-institutional problem list added over half of all validated problems to the health problem list of which 12% were generated by conditions treated by other physicians. Automating the integration of existing information sources provides timely access to accurate and relevant health problem information. It may also accelerate the uptake and use of electronic medical record systems.

【 授权许可】

CC BY   
© Poissant et al; licensee BioMed Central Ltd. 2010