Mining complex clinical data for patient safety research: a framework for event discovery

Successfully addressing patient safety requires detecting medical events effectively. Given the volume of patients seen at medical centers, detecting events automatically from data that are already available electronically would greatly facilitate patient safety work. We have created a framework for electronic detection. Key steps include: selecting target events, assessing what information is available electronically, transforming raw data such as narrative notes into a coded format, querying the transformed data, verifying the accuracy of event detection, characterizing the events using systems and cognitive approaches, and using what is learned to improve detection.

[1]  L I Iezzoni,et al.  A method for screening the quality of hospital care using administrative data: preliminary validation results. , 1992, QRB. Quality review bulletin.

[2]  George Hripcsak,et al.  A Health Information Network for Managing Innercity Tuberculosis: Bridging Clinical Care, Public Health, and Home Care, , 1999, Comput. Biomed. Res..

[3]  W. Kintsch,et al.  Reading comprehension and readability in educational practice and psychological theory , 1979 .

[4]  Jonathan M. Teich,et al.  The impact of computerized physician order entry on medication error prevention. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[5]  H R Warner,et al.  Performance of a diagnostic system (Iliad) as a tool for quality assurance. , 1991, Proceedings. Symposium on Computer Applications in Medical Care.

[6]  R S Evans,et al.  Computerized surveillance of adverse drug events in hospital patients* , 1991, Quality and Safety in Health Care.

[7]  Dieter Zapf,et al.  Introduction: Human Errors and Error Handling , 1994 .

[8]  Donald A. Redelmeier,et al.  Cognitive Science in Medicine: Biomedical Modeling , 1990 .

[9]  J R Scherrer,et al.  The Application of Natural-language Processing to Healthcare Quality Assessment , 1991, Medical decision making : an international journal of the Society for Medical Decision Making.

[10]  E. Gabrieli,et al.  Automated processing of narrative medical text—A new tool for clinical drug studies , 1989, Journal of Medical Systems.

[11]  R S Evans,et al.  Preventing Adverse Drug Events in Hospitalized Patients , 1994, The Annals of pharmacotherapy.

[12]  L L Roos,et al.  Using computers to identify complications after surgery. , 1985, American journal of public health.

[13]  J R Scherrer,et al.  Natural Language Processing and Semantical Representation of Medical Texts , 1992, Methods of Information in Medicine.

[14]  D. Norman,et al.  New technology and human error , 1989 .

[15]  A Burgun,et al.  Automated Coding of Patient Discharge Summaries Using Conceptual Graphs , 1995, Methods of Information in Medicine.

[16]  J. Battles,et al.  Identification and classification of the causes of events in transfusion medicine , 2008, Transfusion.

[17]  L. Nilsson Perspectives on memory research , 1979 .

[18]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[19]  Pieter Adriaans,et al.  Data mining , 1996 .

[20]  Naomi Sager,et al.  Research Paper: Natural Language Processing and the Representation of Clinical Data , 1994, J. Am. Medical Informatics Assoc..

[21]  Jonathan M. Teich,et al.  Potential identifiability and preventability of adverse events using information systems. , 1994, Journal of the American Medical Informatics Association : JAMIA.

[22]  T. Brennan,et al.  The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. , 1991, The New England journal of medicine.

[23]  David W. Bates,et al.  A computerized method for identifying incidents associated with adverse drug events in outpatients , 2001, Int. J. Medical Informatics.

[24]  Carol Friedman,et al.  Research Paper: A General Natural-language Text Processor for Clinical Radiology , 1994, J. Am. Medical Informatics Assoc..

[25]  H S Kaplan,et al.  The attributes of medical event-reporting systems: experience with a prototype medical event-reporting system for transfusion medicine. , 1998, Archives of pathology & laboratory medicine.

[26]  G. Leopold The Federal Register. , 1979, Journal of clinical ultrasound : JCU.

[27]  W. DuMouchel,et al.  Unlocking Clinical Data from Narrative Reports: A Study of Natural Language Processing , 1995, Annals of Internal Medicine.

[28]  David Andreoff Evans,et al.  Cognitive Science in Medicine: Biomedical Modeling , 1989 .

[29]  T. Brennan,et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. , 2000, Medical care.

[30]  Christoph Wick,et al.  Augmented Reality Simulator for Training in Two-Dimensional Echocardiography , 2000, Comput. Biomed. Res..

[31]  George Hripcsak,et al.  Review Paper: Detecting Adverse Events Using Information Technology , 2003, J. Am. Medical Informatics Assoc..

[32]  Walter Kintsch,et al.  Readability and recall of short prose passages: A theoretical analysis. , 1980 .

[33]  Peter D. Stetson,et al.  Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space , 2002, J. Am. Medical Informatics Assoc..

[34]  Stephen B. Johnson,et al.  Design of a clinical event monitor. , 1996, Computers and biomedical research, an international journal.

[35]  D A Giuse,et al.  Increasing the availability of the computerized patient record. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[36]  T. Brennan,et al.  Physician Reporting Compared with Medical-Record Review to Identify Adverse Medical Events , 1993, Annals of Internal Medicine.

[37]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[38]  George Hripcsak,et al.  Natural language processing in an operational clinical information system , 1995, Natural Language Engineering.

[39]  R S Evans,et al.  Computerized surveillance of adverse drug events in hospital patients. 1991. , 1991, Quality & safety in health care.

[40]  R Segal,et al.  Sensitivity and specificity of three methods of detecting adverse drug reactions. , 1988, American journal of hospital pharmacy.

[41]  John F. Sowa,et al.  Conceptual Structures: Information Processing in Mind and Machine , 1983 .

[42]  Evans Da,et al.  Cognitive framework for doctor-patient interaction , 1989 .

[43]  William R. Hersh,et al.  Automatic Prediction of Trauma Registry Procedure Codes from Emergency Room Dictations , 1998, MedInfo.

[44]  George Hripcsak,et al.  Knowledge Discovery Using the Electronic Medical Record , 2002, AMIA.

[45]  D. S. Parker,et al.  Term Domain Distribution Analysis: a Data Mining Tool for Text Databases , 1999, Methods of Information in Medicine.

[46]  Walter Kintsch,et al.  Comprehension: A Paradigm for Cognition , 1998 .

[47]  George Hripcsak,et al.  Medical text representations for inductive learning , 2000, AMIA.

[48]  J Leprohon,et al.  Decision-making Strategies for Telephone Triage in Emergency Medical Services , 1995, Medical decision making : an international journal of the Society for Medical Decision Making.

[49]  L A Lenert,et al.  Automated linkage of free-text descriptions of patients with a practice guideline. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[50]  George Hripcsak,et al.  Coding Neuroradiology Reports for the Northern Manhattan Stroke Study: A Comparison of Natural Language Processing and Manual Review , 2000, Comput. Biomed. Res..

[51]  G Hripcsak,et al.  Accessing the Columbia Clinical Repository. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[52]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[53]  R M Gardner,et al.  Computer surveillance of hospital-acquired infections and antibiotic use. , 1986, JAMA.

[54]  Peter J. Haug,et al.  A Comparison of Classification Algorithms to Automatically Identify Chest X-Ray Reports That Support Pneumonia , 2001, J. Biomed. Informatics.

[55]  John F. Sowa,et al.  Principles of semantic networks , 1991 .

[56]  E. Gabrieli,et al.  Computer-assisted assessment of patient care in the hospital , 1988, Journal of Medical Systems.

[57]  G. Hripcsak,et al.  Extracting Findings from Narrative Reports: Software Transferability and Sources of Physician Disagreement , 1998, Methods of Information in Medicine.

[58]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[59]  Marcia K. Johnson,et al.  Contextual prerequisites for understanding: Some investigations of comprehension and recall , 1972 .

[60]  Charles Safran,et al.  Using an Electronic Medical Record to Perform Clinical Research on Mitral Valve Prolapse and Panic/Anxiety Disorder , 1995 .

[61]  Carl H Frederiksen,et al.  Representing logical and semantic structure of knowledge acquired from discourse , 1975, Cognitive Psychology.

[62]  N M Laird,et al.  A study of medical injury and medical malpractice. , 1989, The New England journal of medicine.

[63]  G Hripcsak,et al.  Natural language processing and its future in medicine. , 1999, Academic medicine : journal of the Association of American Medical Colleges.

[64]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[65]  Stephen B. Johnson,et al.  Extended SQL for manipulating clinical warehouse data , 1999, AMIA.

[66]  Jens Rasmussen,et al.  The Definition of Human Error and a Taxonomy for Technical System Design , 1987 .

[67]  W. Kintsch,et al.  Strategies of discourse comprehension , 1983 .

[68]  Anita Sundaram,et al.  Information Retrieval: A Health Care Perspective , 1996 .

[69]  P. Haug,et al.  Computerized extraction of coded findings from free-text radiologic reports. Work in progress. , 1990, Radiology.

[70]  N L Jain,et al.  Respiratory Isolation of Tuberculosis Patients Using Clinical Guidelines and an Automated Clinical Decision Support System , 1998, Infection Control & Hospital Epidemiology.

[71]  George Hripcsak,et al.  Automating a severity score guideline for community-acquired pneumonia employing medical language processing of discharge summaries , 1999, AMIA.

[72]  T A Pryor,et al.  Rationale for the Arden Syntax. , 1994, Computers and biomedical research, an international journal.

[73]  E. DeLong,et al.  Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes Research , 1993, Annals of Internal Medicine.

[74]  L L Roos,et al.  Complications, comorbidities, and mortality: improving classification and prediction. , 1997, Health services research.

[75]  J. Gaspoz,et al.  Distinction between Planned and Unplanned Readmissions following Discharge from a Department of Internal Medicine , 1999, Methods of Information in Medicine.

[76]  D W Bates,et al.  Evaluation of Screening Criteria for Adverse Events in Medical Patients , 1995, Medical care.

[77]  David C Classen,et al.  Evaluation of a Computer-Assisted Antibiotic-Dose Monitor , 1999, The Annals of pharmacotherapy.

[78]  L. Iezzoni Assessing Quality Using Administrative Data , 1997, Annals of Internal Medicine.

[79]  W. Kintsch The role of knowledge in discourse comprehension : a construction-integration model , 1991 .

[80]  George Hripcsak,et al.  Knowledge discovery and data mining to assist natural language understanding , 1998, AMIA.

[81]  G Hripcsak,et al.  Writing Arden Syntax Medical Logic Modules. , 1994, Computers in biology and medicine.

[82]  Adam Benjamin Wilcox,et al.  Automated classification of medical text reports , 2000 .

[83]  Georges De Moor,et al.  Medical Language Processing applied to extract clinical information from Dutch medical documents , 1998, MedInfo.

[84]  Peter J. Haug,et al.  Research Paper: Automatic Detection of Acute Bacterial Pneumonia from Chest X-ray Reports , 2000, J. Am. Medical Informatics Assoc..

[85]  Jean Charlet,et al.  Evaluating a normalized conceptual representation produced from natural language patient discharge summaries , 1997, AMIA.

[86]  George Hripcsak,et al.  Classification algorithms applied to narrative reports , 1999, AMIA.

[87]  E. Ackermann The Quality in Australian Health Care Study. , 1996, The Medical journal of Australia.

[88]  Jonathan M. Teich,et al.  Research Paper: Identifying Adverse Drug Events: Development of a Computer-based Monitor and Comparison with Chart Review and Stimulated Voluntary Report , 1998, J. Am. Medical Informatics Assoc..

[89]  Peter Spyns Natural Language Processing in Medicine: An Overview , 1996, Methods of Information in Medicine.