Heterogeneity of Drug Allergies and Reaction Lists in Two U.S. Health Care Systems' Electronic Health Records

Abstract

Background Health care institutions have their own “picklist” for clinicians to document adverse drug reactions (ADRs) into the electronic health record (EHR) allergy list. Whether the lack of a nationally standardized picklist impacts clinician data entries is unknown.

Objectives The objective of this study was to assess the impact of defined reaction picklists on clinical documentation and, therefore, downstream analytics and clinical research using these data at two institutions.

Methods ADR data were obtained from the EHRs of patients who visited the emergency department or outpatient clinics at Brigham and Women's Hospital (BWH) and University of Colorado Hospital (UCH) from 2013 to 2018. Reported drug class ADR prevalences were calculated. We investigated the reactions on each picklist and compared the top 40 reactions at each institution, as well as the top 10 reactions within each drug class.

Results Of 2,160,116 patients, 640,444 (30%) had 928,973 active drug allergies. The most commonly reported drug class allergens were similar between BWH and UCH. BWH's picklist had 48 reactions, and UCH's had 160 reactions; 29 reactions were shared by both picklists. While the top four reactions overall (rash, GI upset/nausea/vomiting, hives, itching) were identical between sites, reactions by drug class exhibited greater documentation diversity. For example, while the summed prevalence of swelling-related reactions to angiotensin-converting-enzyme inhibitors was comparable across sites, swelling was represented by two terms (“swelling,” “angioedema”) at BWH but 11 terms at UCH (e.g., “swelling,” “edema,” by body locality).

Conclusion The availability and granularity of reaction picklists impact ADR documentation in the EHR by health care providers; picklists may partially explain variations in reported ADRs across health care systems.

Keywords

clinical documentation - quality of care - interoperability - electronic health records

Author Contributions

S.Y. conducted study design, data acquisition, analysis, and interpretation, drafted the article, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. S.N.S. contributed to data interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. S.V.B. contributed to data analysis and interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. C.A.O. contributed to data analysis and interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. K.G.B. contributed to study design, data analysis, and interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. F.G. contributed to study design, data acquisition, analysis, and interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. D.L.S. contributed to data analysis and interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. P.G.W. contributed to data interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. C.M.M. contributed to data analysis, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. D.W.B. contributed to data interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity. L.Z. conducted study conception and design, contributed to data analysis and interpretation, reviewed the manuscript, gave final approval of the manuscript, and agrees to be accountable for all aspects of the work related to its accuracy or integrity.

Protection of Human and Animal Subjects

This study was approved by the Mass General Brigham Human Research Committee and the Colorado Multiple Institutional Review Board.

Publication History

Received: 08 December 2021

Accepted: 23 May 2022

Accepted Manuscript online:
26 May 2022

Article published online:
04 August 2022

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