Drug reaction diagnostic assistant

Stanford Emerging Apps Lab develops new electronic health record app to help Stanford doctors diagnose life threatening drug reactions 

Heparin‐induced thrombocytopenia (HIT) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) are two immune mediated adverse drug reactions that can be devastating if not properly identified.  Diagnosis of both conditions can be difficult and require the assessment of how clinical data, such as laboratory results, are related in time to when patients receive certain medications.  The electronic health record (EHR) system at Stanford allows clinicians to review patient medications, but then requires navigation to a separate screen to review other relevant clinical data.  In order to evaluate for the presence of drug reactions, clinicians have to manually compare whether certain medications coincide in time with abnormal laboratory results while often also needing to use separate online reference tools to verify diagnostic criteria.  This can be a time consuming process that is subject to high levels of variation and error, leading to missed diagnoses that can affect patient care.  

Bernice Kwong, M.D.

Beth Martin, M.D.

Dr. Bernice Kwong from the Department of Dermatology and Dr. Beth Martin from the Division of Hematology in the Department of Medicine, two Stanford clinicians who often care for patients with these drug reactions, reached out to Dr. Christopher Sharp, the Chief Medical Information Officer at Stanford Health Care, to ask if it would be possible to make changes to the EHR that would allow for a better process.  Although what can be done is limited to the capabilities of the EHR vendor, Dr. Sharp immediately realized that this would be an excellent candidate for leveraging a new method of building home grown web apps at Stanford that can be plugged into the EHR, known as “SMART on FHIR.”  Dr. Sharp referred this request to the newly formed Stanford Emerging Apps Lab (SEAL), which is a joint effort between Research IT and the Digital Healthcare Integration Team at Stanford Health Care to rapidly innovate, build, and implement lightweight digital apps that integrate into the EHR to improve clinical workflows.  

Susan Weber PhD, SEAL’s technical lead, and Dr. Ron Li, SEAL’s clinical informatics lead, collaborated with Dr. Kwong and Dr. Martin to design an app that automatically organizes and visualizes medication and laboratory data in a more clinically meaningful way that is not possible within the current EHR system. 

This is just so incredible and beautiful. Thank you for your tremendous work to make this tool that will truly contribute to improvement of care for our patients, and also for all of us who take care of patients.

Susan’s team of Stanford software developers in Technology & Digital Solutions quickly built and tested an app that met these requirements. The system (screenshot provided below) can be launched from within a patient chart in the EHR and automatically pulls the medications and laboratory results for that specific patient, which are then displayed together in a timeline. Clinicians can also customize which medications and laboratory results they would want to see on the timeline using a filtering mechanism. The initial release of the app has pre-programmed drug and medication filter sets for DRESS and HIT specified by Drs. Kwong and Martin, and can be easily extended to include filter sets suitable for other syndromes.

Once the appropriate filters have been selected, the synchronized medication and lab data tell the patient’s story.

Dr Kwong had this to say:  “This is just so incredible and beautiful. Thank you for your tremendous work to make this tool that will truly contribute to improvement of care for our patients, and also for all of us who take care of patients.” Dr Martin agreed, and then added “This is not only an exceptional support of patient safety but also for clinician wellness“.

The SEAL team builds novel apps to support clinical workflow needs at Stanford Health Care that cannot be addressed by what is available through the EHR system. You can contact them with your suggestions for other apps by filling out the “contact us” page of their website, http://med.stanford.edu/seal.html