In a study conducted by scientists at Eli Lilly and Veradigm,1 unstructured qualitative provider notes recorded in electronic health records (EHRs) during visits with patients with atopic dermatitis (AD) were shown to focus on symptoms primarily and on symptom relief to a lesser extent but only rarely to document AD burden on daily functioning and quality of life.
Published in Dermatology and Therapy, the retrospective observational cohort study of adults and children with a diagnosis of AD evaluated real-world data available from a large ambulatory patient EHR database used by primary care and specialty practices across the United States. From provider notes available in the EHR unstructured fields, nine key terms related to disease, treatment, symptoms, and life and work were identified, and natural language processing (NLP) was applied to determine frequency of terms and to examine bigram (word-pair) patterns. Patient demographic, clinical, and pharmacotherapy data were taken from EHR structured fields.
More than 133,000 adults (48%) and children (52%) with AD were included in the study sample. Disease-related and treatment terms were included in 28% of patient notes. These terms were not well documented for children (0.3%), in contrast to adults, for whom documentation of terms reached 58%. AD burden on functioning and quality of life was not generally documented, regardless of provider specialty (e.g., primary, dermatology, allergy/immunology).
A chronic and relapsing inflammatory skin disease often associated with other manifestations of atopy, AD may significantly affect quality of life, including social functioning and psychological and physical well-being.2,3 Lack of consistency across provider specialties in AD documenting disease activity and severity may impede fuller understanding of its impact and real-world management.
The study demonstrates how combining defined data from EHR structured fields with NLP-extracted information from provider notes captured in unstructured fields offers potential to broaden understanding of AD impact and management. The authors note that the lack of documentation of the burden imposed by AD on their patients’ lives is a potential care gap warranting further investigation and that “discussion of the role of AD on a patient’s life could better inform physicians regarding management and treatment options that could ultimately lead to better management of AD.”