Medication and indication linkage: A practical therapy for the problem list?

Background: Establishing a relationship between medications and diagnoses within a functioning electronic medical record system (EMR) has many valuable applications,such as improving the quality and utility of the problem list to support better decisions.Methods: We evaluated over 1.6 million de-identified patient records from the Regenstrief Medical Record System (RMRS) with over 90 million diagnoses and 20 million medications. Using RxNorm, the VA National Drug File Reference Terminology, and SNOMED-CT (SCT)standard terminologies and mappings we evaluated the linkage for local concept terms for medications and problems (diagnoses & complaints).Results: We were able to map 24,398 candidates as medication and indication pairs. The overall sensitivity and specificity for term pairs was 67.5% and 86% respectively and 39.5% and 97.4 when adjusted for term pair occurrence within single patient records.Conclusions: Medications can be mapped by machine to a disease/ disorder using established terminology standards.This mapping may inform many knowledge management and decision support features in an EMR.