A value set for documenting adverse reactions in electronic health records

Abstract

Objective: To develop a comprehensive value set for documenting and encoding adverse reactions in the allergy module of an electronic health record.

Materials and methods: We analyzed 2 471 004 adverse reactions stored in Partners Healthcare's Enterprise-wide Allergy Repository (PEAR) of 2.7 million patients. Using the Medical Text Extraction, Reasoning, and Mapping System, we processed both structured and free-text reaction entries and mapped them to Systematized Nomenclature of Medicine - Clinical Terms. We calculated the frequencies of reaction concepts, including rare, severe, and hypersensitivity reactions. We compared PEAR concepts to a Federal Health Information Modeling and Standards value set and University of Nebraska Medical Center data, and then created an integrated value set.

Results: We identified 787 reaction concepts in PEAR. Frequently reported reactions included: rash (14.0%), hives (8.2%), gastrointestinal irritation (5.5%), itching (3.2%), and anaphylaxis (2.5%). We identified an additional 320 concepts from Federal Health Information Modeling and Standards and the University of Nebraska Medical Center to resolve gaps due to missing and partial matches when comparing these external resources to PEAR. This yielded 1106 concepts in our final integrated value set. The presence of rare, severe, and hypersensitivity reactions was limited in both external datasets. Hypersensitivity reactions represented roughly 20% of the reactions within our data.

Discussion: We developed a value set for encoding adverse reactions using a large dataset from one health system, enriched by reactions from 2 large external resources. This integrated value set includes clinically important severe and hypersensitivity reactions.

Conclusion: This work contributes a value set, harmonized with existing data, to improve the consistency and accuracy of reaction documentation in electronic health records, providing the necessary building blocks for more intelligent clinical decision support for allergies and adverse reactions.

Figure 1.

Overview of methods. PEAR: Partners Enterprise-wide Allergy Repository; MTERMS: Medical Text Extraction, Reasoning and Mapping System; HSRs: hypersensitivity reactions.

Figure 2.

Adverse reaction lexicon development.

Figure 3

Hypersensitivity reactions (HSRs). ^aImmediate HSRs: Immediate HSRs (time to onset <1 h) are typically IgE-mediated.^bNonimmediate HSRs: Nonimmediate HSRs (time to onset >1 h) are commonly T-cell mediated, but may be antibody- or immune complex–mediated.