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Identifying problematic opioid use in electronic health record data: Are we looking in the right place?

Lori Schirle, PhD, Shinwho Kwun, Ashley Suh, Sandra Sanchez-Roige, PhD, Alvin D. Jeffery, PhD, David C. Samuels, PhD


Objective: To examine the value of data obtained outside of regular healthcare visits (clinical communications) to detect problematic opioid use in electronic health records (EHRs).

Design: A retrospective cohort study.

Participants: Chronic pain patient records in a large academic medical center.

Interventions: We compared evidence for problematic opioid use in (1) clinic notes, (2) clinical communications, and (3) full EHR data. We analyzed keyword counts and calculated concordance and Cohen’s κ between data sources.

Main outcome measure: Evidence of problematic opioid use in EHR defined as none, some, or high.

Results: Twenty-six percent of records were discordant in determination of problematic opioid use between clinical communications and clinic notes. Of these, 54 percent detected more evidence in clinical communications, and 46 percent in clinic notes. Compared to full EHR review, clinic notes exhibited higher concordance (78 percent; κ = 0.619) than clinical communications (60 percent; κ = 0.290).

Conclusion: Clinical communications are a valuable addition to opioid HER research.


opioid use disorder; electronic health records; patient communications; opioid prescriptions; chronic pain

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