Improved Identification of Venous Thromboembolism From Electronic Medical Records Using a Novel Information Extraction Software Platform.

Abstract

The United States federally mandated reporting of venous thromboembolism (VTE), defined by Agency for Healthcare Research & Quality Patient Safety Indicator 12 (AHRQ PSI-12), is based on administrative data, the accuracy of which has not been consistently demonstrated. We used IDEAL-X, a novel information extraction software system, to identify VTE from electronic medical records and evaluated its accuracy. Medical records for 13,248 patients admitted to an orthopedic specialty hospital from 2009 to 2014 were reviewed. Patient encounters were defined as a hospital admission where both surgery (of the spine, hip, or knee) and a radiology diagnostic study that could detect VTE was performed. Radiology reports were both manually reviewed by a physician and analyzed by IDEAL-X. Among 2083 radiology reports, IDEAL-X correctly identified 176/181 VTE events, achieving a sensitivity of 97.2% [95% confidence interval (CI), 93.7%-99.1%] and specificity of 99.3% (95% CI, 98.9%-99.7%) when compared with manual review. Among 422 surgical encounters with diagnostic radiographic studies for VTE, IDEAL-X correctly identified 41 of 42 VTE events, achieving a sensitivity of 97.6% (95% CI, 87.4%-99.6%) and specificity of 99.8% (95% CI, 98.7%-100.0%). The performance surpassed that of AHRQ PSI-12, which had a sensitivity of 92.9% (95% CI, 80.5%-98.4%) and specificity of 92.9% (95% CI, 89.8%-95.3%), though only the difference in specificity was statistically significant (P<0.01). IDEAL-X, a novel information extraction software system, identified VTE from radiology reports with high accuracy, with specificity surpassing AHRQ PSI-12. IDEAL-X could potentially improve detection and surveillance of many medical conditions from free text of electronic medical records.