Improving Allergy Documentation and Clinical Decision Support in the Electronic Health Record (Massachusetts)

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Project Details - Ongoing


Accurate documentation and management of patients’ allergies and adverse reactions to medications, foods, and other substances is vital to patient safety and quality of care. As the sixth leading chronic disease in the U.S., allergies affect 30 percent of adults and 40 percent of children. Furthermore, adverse drug reactions occur in 25 percent of outpatients and 20 percent of inpatients. It is critical to obtain a complete and accurate allergy history for each patient and to provide clinicians with an efficient allergy-alerting clinical decision support tool. However, the allergy modules in most existing electronic health records (EHRs) have serious limitations in how allergies are documented, and how drug allergy alerts are triggered. These limitations include: 1) frequently missing documentation of reaction mechanism and type, 2) lack of a comprehensive terminology, 3) insufficient tools for reconciling allergy information, and 4) physician alert fatigue resulting in an allergy alert override rate of greater than 90 percent.

The overall goal of this project is to improve healthcare quality and safety for allergies. This project will use innovative approaches to redesign the collection and use of allergy information, including an enhanced allergy reaction list, natural language processing, new drug-allergy alerting mechanisms, and increased knowledge generated by domain experts and big data analytics. The study will be conducted at Partners Healthcare in Massachusetts and the University of Colorado Hospital Network, with leaders in informatics, healthcare quality and safety, and allergy and immunology.

The specific aims of this project are as follows:

  • Improve reaction documentation by developing a comprehensive and interactive value set. 
  • Develop an innovative allergy reconciliation module within the EHR. 
  • Redesign drug allergy alerting mechanisms. 
  • Distribute methods and tools to healthcare institutions and the research community. 

The newly developed allergy reconciliation model will be evaluated with a randomized controlled trial in ambulatory clinics. Clinicians at the intervention sites will have access to an allergy reconciliation module in the EHR. The primary outcome is the difference in accuracy and completeness of allergy documentation between the intervention and control practices, as accessed by chart review. The redesigned drug-allergy alerting tool will be tested in a simulation environment measuring the number of alerts generated using real patient data, the number of overridden alerts and reasons for overriding alerts, and unintended errors resulting from the new system. Surveys and focus groups will also be used to evaluate the newly developed technologies.