{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T22:10:03Z","timestamp":1769551803832,"version":"3.49.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T00:00:00Z","timestamp":1580342400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T00:00:00Z","timestamp":1580342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["PO 18-031"],"award-info":[{"award-number":["PO 18-031"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1K12HL138049-01"],"award-info":[{"award-number":["1K12HL138049-01"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Antimicrobial prophylaxis is an evidence-proven strategy for reducing procedure-related infections; however, measuring this key quality metric typically requires manual review, due to the way antimicrobial prophylaxis is documented in the electronic medical record (EMR). Our objective was to electronically measure compliance with antimicrobial prophylaxis using both structured and unstructured data from the Veterans Health Administration (VA) EMR. We developed this methodology for cardiac device implantation procedures.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>With clinician input and review of clinical guidelines, we developed a list of antimicrobial names recommended for the prevention of cardiac device infection. We trained the algorithm using existing fiscal year (FY) 2008\u201315 data from the VA Clinical Assessment Reporting and Tracking-Electrophysiology (CART-EP), which contains manually determined information about antimicrobial prophylaxis. We merged CART-EP data with EMR data and programmed statistical software to flag an antimicrobial orders or drug fills from structured data fields in the EMR and hits on text string searches of antimicrobial names documented in clinician\u2019s notes. We iteratively tested combinations of these data elements to optimize an algorithm to accurately classify antimicrobial use. The final algorithm was validated in a national cohort of VA cardiac device procedures from FY2016\u20132017. Discordant cases underwent expert manual review to identify reasons for algorithm misclassification.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The CART-EP dataset included 2102 procedures at 38 VA facilities with manually identified antimicrobial prophylaxis in 2056 cases (97.8%). The final algorithm combining structured EMR fields and text note search results correctly classified 2048 of the CART-EP cases (97.4%). In the validation sample, the algorithm measured compliance with antimicrobial prophylaxis in 16,606 of 18,903 cardiac device procedures (87.8%). Misclassification was due to EMR documentation issues, such as antimicrobial prophylaxis documented only in hand-written clinician notes in a format that cannot be electronically searched.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We developed a methodology with high accuracy to measure guideline concordant use of antimicrobial prophylaxis before cardiac device procedures using data fields present in modern EMRs. This method can replace manual review in quality measurement in the VA and other healthcare systems with EMRs; further, this method could be adapted to measure compliance in other procedural areas where antimicrobial prophylaxis is recommended.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12911-020-1031-5","type":"journal-article","created":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T18:02:39Z","timestamp":1580407359000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Novel methodology to measure pre-procedure antimicrobial prophylaxis: integrating text searches with structured data from the Veterans Health Administration\u2019s electronic medical record"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4484-0445","authenticated-orcid":false,"given":"Hillary J.","family":"Mull","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Stolzmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Kalver","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlena H.","family":"Shin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marin L.","family":"Schweizer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archana","family":"Asundi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Payal","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maggie","family":"Stanislawski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Westyn","family":"Branch-Elliman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,1,30]]},"reference":[{"issue":"3","key":"1031_CR1","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1161\/CIRCULATIONAHA.109.192665","volume":"121","author":"LM Baddour","year":"2010","unstructured":"Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121(3):458\u201377.","journal-title":"Circulation"},{"issue":"1","key":"1031_CR2","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1093\/europace\/eup362","volume":"12","author":"R Margey","year":"2010","unstructured":"Margey R, McCann H, Blake G, Keelan E, Galvin J, Lynch M, Mahon N, Sugrue D, O'Neill J. Contemporary management of and outcomes from cardiac device related infections. Europace. 2010;12(1):64\u201370.","journal-title":"Europace"},{"issue":"8","key":"1031_CR3","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","volume":"152","author":"SI Berr\u00edos-Torres","year":"2017","unstructured":"Berr\u00edos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017CDC guideline for the prevention of surgical site infection, 2017CDC guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784\u201391.","journal-title":"JAMA Surg"},{"issue":"6","key":"1031_CR4","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1086\/676022","volume":"35","author":"DJ Anderson","year":"2014","unstructured":"Anderson DJ, Podgorny K, Berrios-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605\u201327.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"1031_CR5","doi-asserted-by":"publisher","first-page":"195","DOI":"10.2146\/ajhp120568","volume":"70","author":"DW Bratzler","year":"2013","unstructured":"Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195\u2013283.","journal-title":"Am J Health Syst Pharm"},{"issue":"2","key":"1031_CR6","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1001\/archsurg.140.2.174","volume":"140","author":"DW Bratzler","year":"2005","unstructured":"Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma A, Carr K, Red L. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005;140(2):174\u201382.","journal-title":"Arch Surg"},{"issue":"3","key":"1031_CR7","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1089\/sur.2010.083","volume":"12","author":"LH Rosenberger","year":"2011","unstructured":"Rosenberger LH, Politano AD, Sawyer RG. The surgical care improvement project and prevention of post-operative infection, including surgical site infection. Surg Infect. 2011;12(3):163\u20138.","journal-title":"Surg Infect"},{"key":"1031_CR8","unstructured":"Specifications Manual for Joint Commission National Quality Core Measures (2010A1): Measure Information Form SCIP-Inf-3 [https:\/\/manual.jointcommission.org\/releases\/archive\/TJC2010B\/MIF0112.html]. Accessed 3 Aug 2018."},{"issue":"5","key":"1031_CR9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1017\/ice.2019.51","volume":"40","author":"KM Kuper","year":"2019","unstructured":"Kuper KM, Nagel JL, Kile JW, May LS, Lee FM. The role of electronic health record and \u201cadd-on\u201d clinical decision support systems to enhance antimicrobial stewardship programs. Infect Control Hosp Epidemiol. 2019;40(5):501\u201311.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"5","key":"1031_CR10","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1197\/jamia.M1299","volume":"10","author":"MF Wisniewski","year":"2003","unstructured":"Wisniewski MF, Kieszkowski P, Zagorski BM, Trick WE, Sommers M, et al. Development of a clinical data warehouse for hospital infection control. J Am Med Inform Assoc. 2003;10(5):454\u201362.","journal-title":"J Am Med Inform Assoc"},{"key":"1031_CR11","unstructured":"US Department of Veterans Affairs: 172VA10P2: VHA Corporate Data Warehouse - VA. 79 FR 4377. Updated September 30, 2017. Accessed 1 Oct 2018."},{"issue":"3","key":"1031_CR12","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.ahj.2012.12.009","volume":"165","author":"JB Byrd","year":"2013","unstructured":"Byrd JB, Vigen R, Plomondon ME, Rumsfeld JS, Box TL, Fihn SD, Maddox TM. Data quality of an electronic health record tool to support VA cardiac catheterization laboratory quality improvement: the VA clinical assessment, reporting, and tracking system for Cath labs (CART) program. Am Heart J. 2013;165(3):434\u201340.","journal-title":"Am Heart J"},{"issue":"3 Suppl 1","key":"1031_CR13","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.1097\/MLR.0b013e31827da819","volume":"51","author":"TT Tsai","year":"2013","unstructured":"Tsai TT, Box TL, Gethoffer H, Noonan G, Varosy PD, Maddox TM, Fihn SD, Gross TP, Jesse RL, Rumsfeld JS. Feasibility of proactive medical device surveillance: the VA clinical assessment reporting and tracking (CART) program. Med Care. 2013;51(3 Suppl 1):S57\u201361.","journal-title":"Med Care"},{"issue":"8","key":"1031_CR14","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1017\/ice.2019.127","volume":"40","author":"Archana Asundi","year":"2019","unstructured":"Asundi A, Stanislawski M, Mehta P, Baron AE, Mull HJ, Ho PM, Zimetbaum PJ, Gupta K, Branch-Elliman W. Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: insights from the veterans affairs clinical assessment reporting and tracking program. Infect Control Hosp Epidemiol. 2019;40(8):855\u201362.","journal-title":"Infection Control & Hospital Epidemiology"},{"issue":"9","key":"1031_CR15","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1017\/ice.2018.170","volume":"39","author":"A Asundi","year":"2018","unstructured":"Asundi A, Stanislawski M, Mehta P, Baron AE, Gold H, Mull H, Ho PM, Gupta K, Branch-Elliman W. Prolonged antimicrobial prophylaxis following cardiac device procedures increases preventable harm: insights from the VA CART program. Infect Control Hosp Epidemiol. 2018;39(9):1030\u20136.","journal-title":"Infect Control Hosp Epidemiol"},{"key":"1031_CR16","unstructured":"VA Office of Information and Technology (August 2016). \u201cVistAWeb Version 16.1.8.2 User Manual.\u201d Retrieved 1\/23\/20, from https:\/\/www.va.gov\/vdl\/documents\/Clinical\/VistaWeb\/vistawebusermanual.pdf."},{"issue":"1","key":"1031_CR17","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1089\/sur.2013.9999","volume":"14","author":"DW Bratzler","year":"2013","unstructured":"Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14(1):73\u2013156.","journal-title":"Surg Infect"},{"issue":"1","key":"1031_CR18","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1161\/CIRCEP.108.795906","volume":"2","author":"JC de Oliveira","year":"2009","unstructured":"de Oliveira JC, Martinelli M, Nishioka SA, Varejao T, Uipe D, Pedrosa AA, Costa R, D'Avila A, Danik SB. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ Arrhythm Electrophysiol. 2009;2(1):29\u201334.","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"1031_CR19","unstructured":"Cerner EHR Clinical Solutions [https:\/\/www.cerner.com\/solutions\/clinical-solutions]. Accessed 22 May 2019."},{"key":"1031_CR20","unstructured":"EHR Modernization Homepage [https:\/\/www.ehrm.va.gov\/]. Accessed 9 Aug 2019."},{"key":"1031_CR21","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.jbi.2016.03.026","volume":"61","author":"DD Bui","year":"2016","unstructured":"Bui DD, Del Fiol G, Jonnalagadda S. PDF text classification to leverage information extraction from publication reports. J Biomed Inform. 2016;61:141\u20138.","journal-title":"J Biomed Inform"},{"issue":"9","key":"1031_CR22","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1017\/ice.2016.116","volume":"37","author":"W Branch-Elliman","year":"2016","unstructured":"Branch-Elliman W, Stanislawski M, Strymish J, Baron AE, Gupta K, Varosy PD, Gold HS, Ho PM. Cardiac electrophysiology laboratories: a potential target for antimicrobial stewardship and quality improvement? Infect Control Hosp Epidemiol. 2016;37(9):1005\u201311.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"4","key":"1031_CR23","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1017\/ice.2016.309","volume":"38","author":"P Mehrotra","year":"2017","unstructured":"Mehrotra P, Gupta K, Strymish J, Kramer DB, Lambert-Kerzner A, Ho PM, Branch-Elliman W. Implementation of infection prevention and antimicrobial stewardship in cardiac electrophysiology laboratories: results from the SHEA research network. Infect Control Hosp Epidemiol. 2017;38(4):496\u20138.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"6","key":"1031_CR24","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jacep.2017.01.013","volume":"3","author":"A Basil","year":"2017","unstructured":"Basil A, Lubitz SA, Noseworthy PA, Reynolds MR, Gold H, Yassa D, Kramer D. Periprocedural antibiotic prophylaxis for cardiac implantable electrical device procedures: results from a Heart Rhythm Society survey. JACC Clin Electrophysiol. 2017;3(6):632\u20134.","journal-title":"JACC Clin Electrophysiol"},{"issue":"11","key":"1031_CR25","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1007\/s11882-014-0476-y","volume":"14","author":"E Macy","year":"2014","unstructured":"Macy E. Penicillin and beta-lactam allergy: epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014;14(11):476.","journal-title":"Curr Allergy Asthma Rep"},{"key":"1031_CR26","first-page":"149","volume":"202","author":"G Divita","year":"2014","unstructured":"Divita G, Shen S, Carter ME, Redd A, Forbush T, Palmer M, Samore MH, Gundlapalli AV. Recognizing questions and answers in EMR templates using natural language processing. Stud Health Technol Inform. 2014;202:149\u201352.","journal-title":"Stud Health Technol Inform"},{"issue":"9","key":"1031_CR27","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1017\/ice.2015.122","volume":"36","author":"W Branch-Elliman","year":"2015","unstructured":"Branch-Elliman W, Strymish J, Kudesia V, Rosen AK, Gupta K. Natural language processing for real-time catheter-associated urinary tract infection surveillance: results of a pilot implementation trial. Infect Control Hosp Epidemiol. 2015;36(9):1004\u201310.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"1031_CR28","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s10620-015-3970-8","volume":"62","author":"L Heidemann","year":"2017","unstructured":"Heidemann L, Law J, Fontana RJ. A text searching tool to identify patients with idiosyncratic drug-induced liver injury. Dig Dis Sci. 2017;62(3):615\u201325.","journal-title":"Dig Dis Sci"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-1031-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12911-020-1031-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-1031-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T00:10:18Z","timestamp":1611879018000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-020-1031-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,30]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1031"],"URL":"https:\/\/doi.org\/10.1186\/s12911-020-1031-5","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,30]]},"assertion":[{"value":"24 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"VA Boston Healthcare System Intuitional Review Board approved this research with a waiver of documented informed consent.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"15"}}