Improving Allergy Documentation and Clinical Decision Support in the EHR

摘要 作为美国第六大慢性病，过敏影响了30%的成年人和40%的儿童。不利的 1/4门诊患者和1/5住院患者发生药物反应。许多过敏和不良反应 电子健康记录(EHR)过敏部分的授权文件，以告知未来的医疗护理 还有开处方。获取每个患者的完整和准确的过敏史以及 为临床医生提供高效的过敏警报临床决策支持(CDS)工具。然而， 大多数现有EHR中的过敏模块在记录过敏和药物方面存在严重限制 就会发出过敏警报。这些问题包括：经常缺少关于反应机理和类型的文件， 缺乏一个全面的术语子集来编码不同的反应，工具不足 协调过敏信息和由于警报覆盖率更高而导致的医生警报疲劳 而不是90%。在这项研究中，我们将通过解决以下具体问题来提供这些挑战的解决方案 目标：1)通过开发一个全面和交互的值集来改进反应记录；2) 在电子病历中开发创新的过敏调节模块；3)重新设计药物过敏警报 机制；以及4)将我们的方法和工具分发给医疗机构和研究 社区。

Abstract As the 6th leading chronic disease in the U.S., allergies affect 30% of adults and 40% of children. Adverse drug reactions occur in 1 in 4 outpatients and 1 in 5 inpatients. Many allergies and adverse reactions warrant documentation in the electronic health record (EHR) allergy section to inform future medical care and prescribing. It is critical to obtain a complete and accurate allergy history for each patient and to provide clinicians with an efficient allergy-alerting clinical decision support (CDS) tool. However, the allergy modules in most existing EHRs have serious limitations in how allergies are documented and drug allergy alerts are fired. These include: frequently missing documentation of reaction mechanism and type, lack of a comprehensive terminology subset for encoding diverse reactions, insufficient tools for reconciling allergy information, and physician alert fatigue resulting from an alert override rate of greater than 90%. In this study, we will provide solutions to these challenges by addressing the following specific aims: 1) improve reaction documentation by developing a comprehensive and interactive value set; 2) develop an innovative allergy reconciliation module within the EHR; 3) redesign drug allergy alerting mechanisms; and 4) distribute our methods and tools to healthcare institutions and the research community.