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

Abstract

Background: Healthcare 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: 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: Adverse drug reaction 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 2013-2018. 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, 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 ACE 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). Conclusions: The availability and granularity of reaction picklists impacts ADR documentation in the EHR by healthcare providers; picklists may partially explain variations in reported ADRs across healthcare systems.