| アブストラクト | BACKGROUND: Free text in electronic health records (EHR) may contain additional phenotypic information beyond structured (coded) information. For major health events - heart attack and death - there is a lack of studies evaluating the extent to which free text in the primary care record might add information. Our objectives were to describe the contribution of free text in primary care to the recording of information about myocardial infarction (MI), including subtype, left ventricular function, laboratory results and symptoms; and recording of cause of death. We used the CALIBER EHR research platform which contains primary care data from the Clinical Practice Research Datalink (CPRD) linked to hospital admission data, the MINAP registry of acute coronary syndromes and the death registry. In CALIBER we randomly selected 2000 patients with MI and 1800 deaths. We implemented a rule-based natural language engine, the Freetext Matching Algorithm, on site at CPRD to analyse free text in the primary care record without raw data being released to researchers. We analysed text recorded within 90 days before or 90 days after the MI, and on or after the date of death. RESULTS: We extracted 10,927 diagnoses, 3658 test results, 3313 statements of negation, and 850 suspected diagnoses from the myocardial infarction patients. Inclusion of free text increased the recorded proportion of patients with chest pain in the week prior to MI from 19 to 27%, and differentiated between MI subtypes in a quarter more patients than structured data alone. Cause of death was incompletely recorded in primary care; in 36% the cause was in coded data and in 21% it was in free text. Only 47% of patients had exactly the same cause of death in primary care and the death registry, but this did not differ between coded and free text causes of death. CONCLUSIONS: Among patients who suffer MI or die, unstructured free text in primary care records contains much information that is potentially useful for research such as symptoms, investigation results and specific diagnoses. Access to large scale unstructured data in electronic health records (millions of patients) might yield important insights. |
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| 組織名 | Health Data Research UK London, University College London, 222 Euston Road,;London, NW1 2DA, UK. anoop@doctors.org.uk.;Institute of Health Informatics, University College London, 222 Euston Road,;The National Institute for Health Research University College London Hospitals;Biomedical Research Centre, University College London, 222 Euston Road, London,;NW1 2DA, UK. anoop@doctors.org.uk.;University College London Hospitals NHS Foundation Trust, 235 Euston Road,;London, NW1 2BU, UK. anoop@doctors.org.uk.;London, NW1 2BU, UK.;Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory;Agency, 10 South Colonnade, London, E14 4PU, UK.;London, NW1 2DA, UK.;NW1 2DA, UK.;Department of Biostatistics and Health Informatics, King's College London, De;Crespigny Park, Denmark Hill, London, SE5 8AF, UK. |
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