Medical informatics Linking diseases, drugs, and adverse reactions Lars Juhl Jensen.

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Presentation transcript:

Medical informatics Linking diseases, drugs, and adverse reactions Lars Juhl Jensen

structured data

Jensen et al., Nature Reviews Genetics, 2012

unstructured data

central registries

hospital EHR systems

opt-out

opt-in

registry data

civil registration system

established in 1968

CPR number

Jensen et al., Nature Reviews Genetics, 2012

national discharge registry

14 years

6.2 million patients

45 million admissions

68 million records

119 million diagnosis

ICD-10

Jensen et al., Nature Reviews Genetics, 2012

not research

reimbursement

diagnosis trajectories

comorbidity

contingency table

Jensen et al., Nature Reviews Genetics, 2012

confounding factors

“known knowns”

gender

age

type of hospital encounter

Jensen et al., Nature Communications, 2014

“known unknowns”

smoking

diet

“unknown unknowns”

reporting biases

matched controls

proxy diagnoses

temporal correlations

diagnosis trajectories

Jensen et al., Nature Communications, 2014

trajectory networks

Jensen et al., Nature Communications, 2014

key diagnoses

Jensen et al., Nature Communications, 2014

direct medical implications

clinical text

unstructured data

free text

Danish

complex terminology

busy doctors

abbreviations

misspellings

a lot of it

computer

as smart as a dog

teach it specific tricks

named entity recognition

comprehensive dictionary

diseases

drugs

adverse drug reactions

synonyms

orthographic variation

flexible matching

hyphens and spaces

expansion rules

spelling variants

Clozapine

clozapin clossapin klozapin e chlosapi n chlosapin e chlozapin chlozapin e klossapi n closapin e klozapi n klosapin

“black list”

pest eller kolera

pharmacovigilance

clinical trials

spontaneous reports

underreporting

text/data mining

medication

Jensen et al., Nature Reviews Genetics, 2012

adverse events

hand-crafted rules

Eriksson et al., Drug Safety, 2014

recall known ADRs

estimate ADR frequencies

Eriksson et al., Drug Safety, 2014

discover new ADRs

Drug substanceADEp-value ChlordiazepoxideNystagmus4.0e-8 SimvastatinPersonality changes8.4e-8 DipyridamoleVisual impairment4.4e-4 CitalopramPsychosis8.8e-4 BendroflumethiazideApoplexy8.5e-3 Eriksson et al., Drug Safety, 2014

Acknowledgments Disease trajectories Anders Bøck Jensen Tudor Oprea Pope Moseley Søren Brunak Adverse drug reactions Robert Eriksson Thomas Werge Søren Brunak EHR text mining Peter Bjødstrup Jensen Robert Eriksson Henriette Schmock Francisco S. Roque Anders Juul Marlene Dalgaard Massimo Andreatta Sune Frankild Eva Roitmann Thomas Hansen Karen Søeby Søren Bredkjær Thomas Werge Søren Brunak