Identification of Patients With Diabetes From the Text of Physician Notes in the Electronic Medical Record

Abstract

In this report, we describe a software tool that rapidly and reliably identifies a diagnosis of diabetes documented in physician notes in the electronic medical record. Diabetes care in the U.S. is suboptimal: 20–40% of diabetic patients have inadequate glycemic or blood pressure control or do not have annual eye or foot examinations (1–3). Effective public health surveillance is mandatory to address this problem. It is crucial for the assessment of prevalence of diabetes, its economic and social costs, and evaluation of the dynamics of disease care measures and outcomes (4,5). Disease surveillance can be significantly hampered by the difficulty in identifying the target population (6). A number of approaches have been used to identify patients with diabetes, including death certificates (7,8), billing data (9,10), and surveys (11,12). Each of these methods has its own shortcomings, and sensitivity remains relatively low. Consequently, manual chart review remains the gold standard for the identification of individuals diagnosed with a particular disease. This is a labor-intensive process that is not scalable to the level needed in public health surveillance. Because most elements of the patient chart are increasingly available in digital format, there have been a number of attempts to …