2058. VistA Progress Notes as a Source for Adverse Drug Event Signals
John F Hurdle, MD, PhD, VA Salt Lake City HCS GRECC and University of Utah, JM Hoffman, VA Salt Lake City HCS GRECC, S Satsangi,
University of Utah
Objectives: To assess the utility of using computerized, context-informed keyword searching of VistA progress notes as a signaling method for adverse drug events (ADEs).
Methods: As a pilot we used the charts of patients who had a documented ADE of somnolence. Three physicians and two clinical pharmacists derived somnolence-specific keywords several ways (e.g., reading somnolence charts; reviewing UMLS). We extracted and context-formatted all progress notes from VistA, scanning them for keywords. The gold standard for ADEs comes from a large corpus of well-described events we found in an earlier HSRD-funded ADE surveillance.
Results: We surveyed 40% of all admissions (n=937) over a 20-week period (2000). There were 521 ADEs, 82.4% were signaled in part from progress notes. Seventeen patients has 20 somnolence ADEs. For all admissions there were 88,217 notes written; 10,372 contained a somnolence keyword; 386 were written in a somnolence ADE admission. Somnolence notes contained a keyword 93.1% of the time, but all patients had at least one keyword 69% of the time. However, somnolence patientsí notes had a keyword in 14 notes (mean), while all other patients averaged less than 7. When adjusted for note context (author type or note title), somnolence keywords show improved specificity.
Conclusions: Keywords show promise for augmenting standard ADE signals drawn from labs and pharmacy orders. Data from non-physicians, especially nurses, are useful in many contexts.
Impact: We showed in an earlier study that ADEs are serious problem; keyword scanning to augment other surveillance measures should help improve Veteran ADE outcomes.