A Prototype Knowledge Base and SMART App to Facilitate Organization of Patient Medications by Clinical Problems

Increasing use of electronic health records requires comprehensive patient-centered views of clinical data. We describe a prototype knowledge base and SMART app that facilitates organization of patient medications by clinical problems, comprising a preliminary step in building such patient-centered views. The knowledge base includes 7,164,444 distinct problem-medication links, generated from RxNorm, SNOMED CT, and NDF-RT within the UMLS Metathesaurus. In an evaluation of the knowledge base applied to 5000 de-identified patient records, 22.4% of medications linked to an entry in the patient's active problem list, compared to 32.6% of medications manually linked by providers; 46.5% of total links were unique to the knowledge base, not added by providers. Expert review of a random patient subset estimated a sensitivity of 37.1% and specificity of 98.9%. The SMART API successfully utilized the knowledge base to generate problem-medication links for test patients. Future work is necessary to improve knowledge base sensitivity and efficiency.