Characterizing the use and contents of free-text family history comments in the electronic health record.
ABSTRACT The detailed collection of family history information is becoming increasingly important for patient care and biomedical research. Recent reports have highlighted the need for efforts to better understand collection and use of this information in resources such as the Electronic Health Record (EHR). This two-part study involved characterizing the use and contents of free-text comments within the family history section of an EHR. Based on a manual review of a subset of 11,456 cancer-related family history entries, 20 "reasons for use" were identified and the distribution across these reasons determined. A semi-automated analysis of the 3,358 unique comments associated with these entries was then performed to identify and quantify key categories of information. Implications of this study include guiding efforts for the improved use, collection, and subsequent analysis of family history information in the EHR.
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ABSTRACT: The collection of a family history ranges from simply asking patients if family members have the same presenting illness to diagramming complex medical and psychosocial relationships as part of a family genogram. The three-generation pedigree provides a pictorial representation of diseases within a family and is the most efficient way to assess hereditary influences on disease. Two recent events have made family history assessment more important than ever: the completion of the Human Genome Project with resultant identification of the inherited causes of many diseases, and the establishment of national clinical practice guidelines based on systematic reviews of preventive interventions. The family history is useful in stratifying a patient's risk for rare single-gene disorders and more common diseases with multiple genetic and environmental contributions. Major organizations have endorsed using standardized symbols in pedigrees to identify inherited contributions to disease.American family physician 09/2005; 72(3):441-8. · 1.82 Impact Factor
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ABSTRACT: Genetics has transformed the use of family history information and has led to the reemergence of the detailed genetic family history. It is critical that public and professional educational efforts to increase family history awareness and working knowledge are prioritized. Patient maintenance of the pedigree provides increased patient awareness and facilitates some of the limitations associated with conventional medical history ascertainment, ultimately improving health care and research. The increasing use of genetic screening promises to cultivate a paradigm shift in medical treatment emphasizing primary prevention and early intervention. Appreciation of the family history is necessary to make this important advance.Critical Care Nursing Clinics of North America 07/2008; 20(2):149-58, v. DOI:10.1016/j.ccell.2008.01.004 · 0.43 Impact Factor
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ABSTRACT: Problem lists are fundamental to electronic medical records (EMRs). However, obtaining an appropriate problem list dictionary is difficult, and getting users to code their problems at the time of data entry can be challenging. To develop a problem list dictionary and search algorithm for an EMR system and evaluate its use. We developed a problem list dictionary and lookup tool and implemented it in several EMR systems. A sample of 10,000 problem entries was reviewed from each system to assess overall coding rates. We also performed a manual review of a subset of entries to determine the appropriateness of coded entries, and to assess the reasons other entries were left uncoded. The overall coding rate varied significantly between different EMR implementations (63-79%). Coded entries were virtually always appropriate (99%). The most frequent reasons for uncoded entries were due to user interface failures (44-45%), insufficient dictionary coverage (20-32%), and non-problem entries (10-12%). The problem list dictionary and search algorithm has achieved a good coding rate, but the rate is dependent on the specific user interface implementation. Problem coding is essential for providing clinical decision support, and improving usability should result in better coding rates.International Journal of Medical Informatics 01/2004; 72(1-3):17-28. DOI:10.1016/j.ijmedinf.2003.08.002 · 2.72 Impact Factor