Design:  Multi-disciplinary stakeholders formed the Allergy Consensus Committee (ACC) who identified and prioritized lists of medication, food and environmental allergens in the electronic health record (EHR) by prevalence, impact on quality improvement, and patient safety risk. Free text remediation strategies included creating and mapping to new structured entries, deletion and transfer to patient problem list. This iterative process leveraged automated as well as manual remediation strategies.

Main Findings:  Over 100,000 allergen entries were targeted. Environmental allergens, no known drug allergy (NKDA), contrast media, and food allergens were the most commonly free-texted entries. Over 10,000 free text environmental allergens were reclassified as a problem list entry, over 5,000 free text nut entries were mapped to coded entries, and over 6,000 free texted NKDA entries were deleted. Beta lactams, sulfonamides, other foods and latex comprised the majority of remaining remediated allergen groups.

Impact on Practice:  Information in the EHR allergy module should be accurate, actionable, and accessible. Free-texted allergy entries introduce inaccuracies and cripple clinical decision support systems. We present a framework and specific, step-wise intervention to remediate free text allergies, which is key to improve care quality, prevent adverse events, and promote patient safety.

Submitted by Dinah Foer and Lily Li from Brigham and Women's Hospital