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Objective Data from electronic healthcare records (EHR) can be used to monitor drug safety, but in order to compare and pool data from different EHR databases, the extraction of potential adverse events must be harmonized. In this paper, we describe the procedure used for harmonizing the extraction from eight European EHR databases of five events of interest deemed to be important in pharmacovigilance: acute myocardial infarction (AMI); acute renal failure (ARF); anaphylactic shock (AS); bullous eruption (BE); and rhabdomyolysis (RHABD). Design The participating databases comprise general practitioners’ medical records and claims for hospitalization and other healthcare services. Clinical information is collected using four different disease terminologies and free text in two different languages. The Unified Medical Language System was used to identify concepts and corresponding codes in each terminology. A common database model was used to share and pool data and verify the semantic basis of the event extraction queries. Feedback from the database holders was obtained at various stages to refine the

Objectives: The aim of this research was to automate the search of publications concerning adverse drug reactions (ADR) by defining the queries used to search MEDLINE and by determining the required threshold for the number of extracted publications to confirm the drug/event association in the literature. Methods: We defined an approach based on the medical subject headings (MeSH) 'descriptor records' and 'supplementary concept records' thesaurus, using the subheadings 'chemically induced' and 'adverse effects' with the 'pharmacological action' knowledge. An expert-built validation set of true positive and true negative drug/adverse event associations (n=61) was used to validate our method. Results: Using a threshold of three of more extracted publications, the automated search method presented a sensitivity of 90% and a specificity of 100%. For nine different drug/event pairs selected, the recall of the automated search ranged from 24% to 64% and the precision from 93% to 48%. Conclusions: This work presents a method to find previously established relationships between drugs and adverse events in the literature. Using MEDLINE, following a MeSH approach to filter the signals, is a valid option. Our contribution is available as a web service that will be integrated in the final European EU-ADR project (Exploring and Understanding Adverse Drug Reactions by integrative mining of clinical records and biomedical knowledge) automated system.

OBJECTIVE: Data from electronic healthcare records (EHR) can be used to monitor drug safety, but in order to compare and pool data from different EHR databases, the extraction of potential adverse events must be harmonized. In this paper, we describe the procedure used for harmonizing the extraction from eight European EHR databases of five events of interest deemed to be important in pharmacovigilance: acute myocardial infarction (AMI); acute renal failure (ARF); anaphylactic shock (AS); bullous eruption (BE); and rhabdomyolysis (RHABD). DESIGN: The participating databases comprise general practitioners' medical records and claims for hospitalization and other healthcare services. Clinical information is collected using four different disease terminologies and free text in two different languages. The Unified Medical Language System was used to identify concepts and corresponding codes in each terminology. A common database model was used to share and pool data and verify the semantic basis of the event extraction queries. Feedback from the database holders was obtained at various stages to refine the extraction queries. MEASUREMENTS: Standardized and age specific incidence rates (IRs) were calculated to facilitate benchmarking and harmonization of event data extraction across the databases. This was an iterative process. RESULTS: The study population comprised overall 19 647 445 individuals with a follow-up of 59 929 690 person-years (PYs). Age adjusted IRs for the five events of interest across the databases were as follows: (1) AMI: 60-148/100 000 PYs; (2) ARF: 3-49/100 000 PYs; (3) AS: 2-12/100 000 PYs; (4) BE: 2-17/100 000 PYs; and (5) RHABD: 0.1-8/100 000 PYs. CONCLUSIONS: The iterative harmonization process enabled a more homogeneous identification of events across differently structured databases using different coding based algorithms. This workflow can facilitate transparent and reproducible event extractions and understanding of differences between datab

The overall objective of the EU-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

INTRODUCTION Detection of clinical events from diverse electronic sources of information such as hospital discharge claims (HOSP), death registries (DEATH), laboratory values (LAB), and general practice databases (GP) may be useful for various epidemiological purposes. In particular, the EU-ADR project aims to detect adverse events deemed to be important in pharmacovigilance. Eight databases (DBs) from four countries, combining different sources of information, participate in the project. A common conceptual framework was lacking to describe harmoniously the algorithm by which each DB detected each event. OBJECTIVES Describe the algorithms that 8 different DBs used to identify 6 events: Acute myocardial infarction (AMI), Acute Renal Failure (ARF), Anaphylactic Shock (AS), Bullous Eruption (BE), Rhabdomyolysis (RHABD), Upper Gastrointestinal Bleeding (UGIB). Benchmark corresponding incidence rates (IRs). METHODS A list of medical concepts corresponding to each event of interest was provided and projected to the DSs different coding systems (ICD9, ICD10, READ, ICPC) and natural languages through the Unified Medical Language System (UMLS). Specific sources of information contained in each DB were classified in a common framework and DBs with similar structures were asked to search for concepts within the same sources. RESULTS Concepts were mainly searched for in GP diagnoses and primary diagnoses of HOSP, but for some events DEATH (AMI, ARF, AS) and LAB (RHABD) were independently used by DBs having them. Resulting age-adjusted IRs vary as follows across DBs: 1-2/1,000PY (AMI), 3-7/10,000PY (UGIB), 2-12/100,000PY (AS), 2-17/100,000PY (BE), 1-8/100,000PY (RHABD), 3-49/100,000PY (ARF). CONCLUSIONS It is possible to describe event extractions from heterogeneous DBs in a common conceptual framework. Residual differences in IRs may be due either to differences in the underlying populations or to differences in the characteristics (structure, coding system) of the DBs.