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Abstract
BackgroundMedication trend studies show the changes of medication over the years and may be replicated using a clinical Data Warehouse (CDW). Even nowadays, a lot of the patient information, like medication data, in the EHR is stored in the format of free text. As the conventional approach of information extraction (IE) demands a high developmental effort, we used ad hoc IE instead. This technique queries information and extracts it on the fly from texts contained in the CDW.MethodsWe present a generalizable approach of ad hoc IE for pharmacotherapy (medications and their daily dosage) presented in hospital discharge letters. We added import and query features to the CDW system, like error tolerant queries to deal with misspellings and proximity search for the extraction of the daily dosage. During the data integration process in the CDW, negated, historical and non-patient context data are filtered. For the replication studies, we used a drug list grouped by ATC (Anatomical Therapeutic Chemical Classification System) codes as input for queries to the CDW.ResultsWe achieve an F1 score of 0.983 (precision 0.997, recall 0.970) for extracting medication from discharge letters and an F1 score of 0.974 (precision 0.977, recall 0.972) for extracting the dosage. We replicated three published medical trend studies for hypertension, atrial fibrillation and chronic kidney disease. Overall, 93% of the main findings could be replicated, 68% of sub-findings, and 75% of all findings. One study could be completely replicated with all main and sub-findings.ConclusionA novel approach for ad hoc IE is presented. It is very suitable for basic medical texts like discharge letters and finding reports. Ad hoc IE is by definition more limited than conventional IE and does not claim to replace it, but it substantially exceeds the search capabilities of many CDWs and it is convenient to conduct replication studies fast and with high quality.
Highlights
Medication trend studies show the changes of medication over the years and may be replicated using a clinical Data Warehouse (CDW)
This is reflected by many studies reporting medication trends: e.g. attention deficit hyperactivity disorder (ADHD) [1], atrial fibrillation (AF)
At the end of the pipeline, all values are stored in the Lucene index and can be queried from physicians in the PaDaWaN Web Graphical user interface (GUI) [23]
Summary
Medication trend studies show the changes of medication over the years and may be replicated using a clinical Data Warehouse (CDW). Reliable information on the use of medication in a hospital and its changes over time is of great importance for many acute and chronic diseases – from a hospital, patient and payor perspective This is reflected by many studies reporting medication trends: e.g. attention deficit hyperactivity disorder (ADHD) [1], atrial fibrillation (AF) (US [2], Denmark [3, 4]), chronic kidney disease (CKD) [5, 6], rheumatoid disease [7] or hypertension (HT) [8] (England [9], France [10], Germany [11], Sweden [12], US [13, 14]). Replication of medication trend studies can be performed using a CDW, which is an important, albeit little exploited and published use case
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