Automated ascertainment of bleeding and target lesion revascularization after percutaneous coronary intervention (PCI) using electronic health record (EHR) data

项目总结 经皮冠状动脉介入治疗(PCI)是最常见的心脏手术，超过650,000例 在美国每年进行一次。在相当大比例的患者中发生的术后并发症是 与发病和死亡风险增加有关。经皮冠状动脉介入术后事件的可靠确定 对于性能测量、提交给疾病登记、临床试验和心脏 导尿室(CCL)安全监测。基于索赔的冠状动脉介入治疗并发症的检测是不够的。 可靠地评估冠状动脉介入术后事件需要深入的手动图表检查，这会导致显著的 提供者和行政负担。然而，随着卫生信息技术和全国范围内的进步 采用电子健康记录(EHR)系统，可以利用EHR自动导出 临床事件。Murugiah博士建议创建和验证自动化算法，这些算法可以应用于 EHR数据，以检测两个重要的PCI术后事件，这两个事件是临床试验和质量的共同焦点 改善努力-住院出血和1年目标病变血运重建(TLR)。在以下位置使用EHR数据 作为一个大型的医疗系统，Murugiah博士将开发一种混合算法来检测PCI术后的大出血 利用实验室值等结构化数据字段以及成像等非结构化数据 结合自然语言处理(NLP)的报告、心导管检查报告和进度记录 技术(目标1)。同样，对重复接受心导管术的患者使用导管术报告 血运重建在1年内，将开发一种算法来检测TLR(目标2)。两种算法都将是 使用另一家大型机构的EHR数据进行外部验证。最终的算法将被实现到 生成计划的出血和TLR报告的工具，反馈给质量保证团队 CCL和单个运营商。将对各个操作员进行调查以获得关于该算法的反馈， 报告流程，以及他们所感受到的好处。最终的工具将成为开源工具(Aim 3)。一种自动化的 用于检测EHR内的PCI后事件的算法可以减轻管理负担，使 从基于EHR的观察性研究中产生新知识，并实现务实的临床试验。 此外，该项目可以作为利用这两种结构化数据的混合工具效用的概念证明 和用于监测和质量测量的临床文本。Murugiah博士的职业兴趣是研究和 利用多维数据集和EHR数据开发改进缺血性心脏病的治疗 实时风险预测模型和决策支持工具，并进行基于EHR的有效性比较 研究和临床试验。在颁奖期间，他将利用他的指导团队的经验 它包括心血管结果研究、临床信息学和计算方面的国家专家 语言学。他还将通过完成健康科学硕士学位获得临床信息学的正式培训 这将为他提供必要的平台，使他能够转型为一名独立的调查员。

PROJECT SUMMARY Percutaneous coronary intervention (PCI) is the most common cardiac procedure with over 650,000 PCI performed annually in the U.S. Post-PCI complications which occur in a significant proportion of patients are associated with an increased risk of morbidity and mortality. Reliable ascertainment of post-PCI events is important for performance measurement, submission to disease registries, clinical trials, and for cardiac catheterization laboratory (CCL) safety monitoring. Claims based detection of PCI complications is inadequate. Assessing post-PCI events reliably requires an in-depth manual chart review, which incurs a significant provider and administrative burden. However, with advances in health information technology and nationwide adoption of electronic health record (EHR) systems, it possible to utilize EHR for the automatic derivation of clinical events. Dr. Murugiah proposes to create and validate automated algorithms which can be applied to EHR data to detect two important post-PCI events which are a common focus of clinical trials and quality improvement efforts – in-hospital bleeding and 1-year target lesion revascularization (TLR). Using EHR data at a large health system, Dr. Murugiah will develop a hybrid algorithm to detect major bleeding post-PCI by leveraging structured data fields such as laboratory values, as well as unstructured data such as imaging reports, cardiac catheterization reports, and progress notes incorporating Natural Language Processing (NLP) techniques (Aim 1). Similarly, using cardiac catheterization reports for patients undergoing repeat revascularization within 1 year, an algorithm will be developed to detect TLR (Aim 2). Both algorithms will be externally validated using EHR data from another large institution. The final algorithm will be implemented into a tool generating scheduled reports of bleeding and TLR, to be fed back to the quality assurance team for the CCL and to individual operators. Individual operators will be surveyed to obtain feedback about the algorithm, reporting process, and their perceived benefit. The final tools will be made open source (Aim 3). An automated algorithm for the detection of post-PCI events within EHR can reduce administrative burden, enable the generation of new knowledge from EHR based observational studies, and enable pragmatic clinical trials. Further, this project can serve as a proof of concept of the utility of hybrid tools leveraging both structured data and clinical text for surveillance and quality measurement. Dr. Murugiah has a career interest in studying and improving the treatment for ischemic heart disease using multidimensional datasets and EHR data to develop real time risk prediction models and decision support tools, and conduct EHR based comparative effectiveness studies and clinical trials. During the award period he will leverage the experience of his mentorship team which includes national experts in cardiovascular outcomes research, clinical informatics, and computational linguistics. He will also acquire formal training in clinical informatics by completing a Master of Health Science degree which will provide him the necessary platform to make the transition into an independent investigator.