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J Am Board Fam Med. 2015 Jan-Feb;28(1):65-71. doi: 10.3122/jabfm.2015.01.140181.

Monitoring suicidal patients in primary care using electronic health records.

Author information

1
From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA). heather.anderson@ucdenver.edu.
2
From the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).

Abstract

INTRODUCTION:

Patients at risk for suicide often come into contact with primary care providers, many of whom use electronic health records (EHRs) for charting. It is not known, however, how often suicide ideation or attempts are documented in EHRs.

METHODS:

We used retrospective analyses of de-identified EHR data from a distributed health network of primary care organizations to estimate the frequency of using diagnostic codes to record suicidal ideation and attempts. Data came from 3 sources: a clinician notes field processed using natural language processing; a suicidal ideation item on a patient-reported depression severity instrument (9-item Patient Health Questionnaire [PHQ-9]); and diagnostic codes from the EHR.

RESULTS:

Only 3% of patients with an indication of suicidal ideation in the notes field had a corresponding International Classification of Diseases, 9th Revision (ICD-9), code (κ = 0.036). Agreement between an indication of suicidal ideation from item 9 of the PHQ-9 and an ICD-9 code was slightly higher (κ = 0.068). Suicide attempt indicated in the notes field was more likely to be recorded using an ICD-9 code (19%; κ = 0.18).

CONCLUSIONS:

Few cases of suicidal ideation and attempt were documented in patients' EHRs using diagnostic codes. Increased documentation of suicidal ideation and behaviors in patients' EHRs may improve their monitoring in the health care system.

KEYWORDS:

Attempted; Electronic Health Records; Natural Language Processing; Suicidal Ideation; Suicide

PMID:
25567824
DOI:
10.3122/jabfm.2015.01.140181
[Indexed for MEDLINE]
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