A collaborative approach to developing an electronic health record phenotyping algorithm for drug-induced liver injury. Academic Article uri icon

Overview

MeSH

  • Humans

MeSH Major

  • Algorithms
  • Chemical and Drug Induced Liver Injury
  • Electronic Health Records
  • Phenotype

abstract

  • To describe a collaborative approach for developing an electronic health record (EHR) phenotyping algorithm for drug-induced liver injury (DILI). We analyzed types and causes of differences in DILI case definitions provided by two institutions-Columbia University and Mayo Clinic; harmonized two EHR phenotyping algorithms; and assessed the performance, measured by sensitivity, specificity, positive predictive value, and negative predictive value, of the resulting algorithm at three institutions except that sensitivity was measured only at Columbia University. Although these sites had the same case definition, their phenotyping methods differed by selection of liver injury diagnoses, inclusion of drugs cited in DILI cases, laboratory tests assessed, laboratory thresholds for liver injury, exclusion criteria, and approaches to validating phenotypes. We reached consensus on a DILI phenotyping algorithm and implemented it at three institutions. The algorithm was adapted locally to account for differences in populations and data access. Implementations collectively yielded 117 algorithm-selected cases and 23 confirmed true positive cases. Phenotyping for rare conditions benefits significantly from pooling data across institutions. Despite the heterogeneity of EHRs and varied algorithm implementations, we demonstrated the portability of this algorithm across three institutions. The performance of this algorithm for identifying DILI was comparable with other computerized approaches to identify adverse drug events. Phenotyping algorithms developed for rare and complex conditions are likely to require adaptive implementation at multiple institutions. Better approaches are also needed to share algorithms. Early agreement on goals, data sources, and validation methods may improve the portability of the algorithms.

publication date

  • December 2013

has subject area

  • Algorithms
  • Chemical and Drug Induced Liver Injury
  • Electronic Health Records
  • Humans
  • Phenotype

Research

keywords

  • Journal Article

Identity

Language

  • eng

PubMed Central ID

  • PMC3861914

Digital Object Identifier (DOI)

  • 10.1136/amiajnl-2013-001930

PubMed ID

  • 23837993

Additional Document Info

start page

  • e243

end page

  • e252

volume

  • 20

number

  • e2