BMC Med Inform Decis Mak - Assessing the accuracy of an inter-institutional automated patient-specific health problem list.

Tópicos

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Resumo

CKGROUND: Health 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.METHODS: Data 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.RESULTS: A 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.CONCLUSION: Automation 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.

Resumo Limpo

ckground health problem list key compon electron health record instrument develop decisionsupport system encourag best practic optim patient safeti health problem list requir initi clinic inform enter manual integr inform across care provid institut studi assess accuraci novel approach creat interinstitut autom health problem list computer medic record moxxi integr three sourc inform individu patient diagnost code medic servic claim treat physician therapeut indic electron prescript singleind drugsmethod data studi obtain general practition medic servic provid patient open patient file health problem detect medic servic util singleind drug use flag physician moxxi system new aris health problem present potenti physician prompt specifi health problem valid y n prefer reassess valid later timeresult total health problem repres uniqu problem identifi group patient medic servic claim contribut major problem identifi follow therapeut indic electron prescript singleind drug physician activ chose assess n health problem overal problem assess consid valid origin medic servic diagnost code singl indic drug prescript indic twelv percent problem identifi treat physician consid valid compar identifi studi physician claimsconclus autom interinstitut problem list ad half valid problem health problem list generat condit treat physician autom integr exist inform sourc provid time access accur relev health problem inform may also acceler uptak use electron medic record system

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