Evaluation of structured data from electronic health records to identify clinical classification criteria attributes for systemic lupus erythematosus

Abstract

Objective: Our objective was to develop algorithms to identify lupus clinical classification criteria attributes using structured data found in the electronic health record (EHR) and determine whether they could be used to describe a cohort of people with lupus and discriminate them from a defined healthy control cohort.

Methods: We created gold standard lupus and healthy patient cohorts that were fully adjudicated for the American College of Rheumatology (ACR), Systemic Lupus International Collaborating Clinics (SLICC) and European League Against Rheumatism/ACR (EULAR/ACR) classification criteria and had matched EHR data. We implemented rule-based algorithms using structured data within the EHR system for each attribute of the three classification criteria. Individual criteria attribute and classification criteria algorithms as a whole were assessed over our combined cohorts and the overall performance of the algorithms was measured through sensitivity and specificity.

Results: Individual classification criteria attributes had a wide range of sensitivities, 7% (oral ulcers) to 97% (haematological disorders) and specificities, 56% (haematological disorders) to 98% (photosensitivity), but all could be identified in EHR data. In general, algorithms based on laboratory results performed better than those primarily based on diagnosis codes. All three classification criteria systems effectively distinguished members of our case and control cohorts, but the SLICC criteria-based algorithm had the highest overall performance (76% sensitivity, 99% specificity).

Conclusions: It is possible to characterise disease manifestations in people with lupus using classification criteria-based algorithms that assess structured EHR data. These algorithms may reduce chart review burden and are a foundation for identifying subpopulations of patients with lupus based on disease presentation to support precision medicine applications.

Keywords: autoimmune diseases; epidemiology; systemic lupus erythematosus.

Figure 1

Sensitivity and specificity of classification criteria attributes in electronic health record (EHR) data. The algorithms for 29 attribute components of the ACR, SLICC and EULAR/ACR classification criteria were assessed for sensitivity and specificity of attribute detection in EHR data relative to chart adjudication results for the same patients. For each attribute, sensitivity is displayed via coloured bars and specificity by the black points. Sensitivity bars for clinical attributes are shown in red and immunological attributes are shown in blue. ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; SLICC, Systemic Lupus International Collaborating Clinics.