Automated Dynamic Lists for Efficient Electronic Health Record Management

描述（由申请人提供）：医疗差错被认为是许多死亡的原因，即使有些是难以避免的，许多是可以预防的。已经提出了具有决策支持的计算机化医嘱输入系统来降低这种用药错误的风险，但是这些系统依赖于电子健康记录（EHR）中的结构化和编码信息。不幸的是，EHR中的大部分信息仅在叙述性临床文件中提及。大多数EHR都提供了问题和过敏的电子列表，但它们需要用户手动管理，以添加新问题，修改现有问题，并删除不相关的问题。因此，这些电子清单往往不完整、不准确和过时。Clinacuity，Inc.提出 开发一个新的系统，从癌症患者的电子病历中的临床叙述文本中自动提取结构化和编码的医疗问题和过敏症。为了建立这样一个系统的优点和可行性，我们将致力于以下目标：1）创建一个用于培训和测试信息提取应用程序的参考标准，该参考标准包括在亨斯迈癌症研究所癌症诊所接受治疗的患者的去识别临床叙述的随机样本（盐湖，犹他州），有领域专家注释的问题和过敏; 2）开发一个原型来自动提取医疗问题和过敏，实施一种新的逐步混合方法，首先最大限度地提高灵敏度，并且还增强阳性预测值;以及3）使用用于训练和测试的交叉验证方法，用上述参考标准测试原型。商业应用：Clinacuity提出的系统不仅可以帮助医疗保健提供者维护完整和及时的问题和过敏列表，为他们提供患者的有效概述，还可以帮助医疗保健组织达到有意义的使用要求。所提出的系统在住院和门诊设置中具有潜在的商业应用，通过节省时间来提高忙碌的医疗保健提供者的效率，并帮助医疗保健组织展示“有意义的使用”并获得医疗保险和医疗补助服务中心的奖励支付。Clinacuity将进一步扩展该系统的商业潜力，并使用模块化设计原则，允许独立使用每个模块，并增强其本地适应性，以便于部署。

DESCRIPTION (provided by APPLICANT): Medical errors are recognized as the cause of numerous deaths, and even if some are difficult to avoid, many are preventable. Computerized physician order-entry systems with decision support have been proposed to reduce this risk of medication errors, but these systems rely on structured and coded information in the electronic health record (EHR). Unfortunately, a substantial proportion of the information available in the EHR is only mentioned in narrative clinical documents. Electronic lists of problems and allergies are available in most EHRs, but they require manual management by their users, to add new problems, modify existing ones, and the removal of the ones that are irrelevant. Consequently, these electronic lists are often incomplete, inaccurate, and out of date. Clinacuity, Inc. proposes to develop a new system to automatically extract structured and coded medical problems and allergies from clinical narrative text in the EHR of patients suffering from cancer. To establish the merit and feasibility of such a system, we will work on the following objectives: 1) create a reference standard for training and testing the information extraction application, a reference standard including a random sample of de-identified clinical narratives from patients treated at the Huntsman Cancer Institute Cancer Clinics (Salt Lake City, Utah), with problems and allergies annotated by domain experts; 2) develop a prototype to automatically extract medical problems and allergies, implementing a novel stepwise hybrid approach to maximize sensitivity first, and also enhance positive predictive value; and 3) test the prototype with the aforementioned reference standard, using a cross-validation approach for training and testing. Commercial application: The system Clinacuity proposes will not only help healthcare providers maintain complete and timely lists of problems and allergies, providing them with an efficient overview of a patient, but also help healthcare organizations attain meaningful use requirements. The proposed system has potential commercial applications in inpatient and outpatient settings, increasing the efficiency of busy healthcare providers by saving time, and aiding healthcare organizations in demonstrating "meaningful use" and obtaining Centers for Medicare and Medicaid Services incentive payments. Clinacuity will further extend the commercial potential of the system and it is output, using modular design principles allowing utilization of each module independently, and enhancing its local adaptability for easier deployment.