Table 1.
% | |
---|---|
PHT Coding Category | |
1. Provider name | 91 |
2. Team name/color | 100 |
3. Provider pager Number | 75 |
4. Patient name | 100 |
5. Patient age | 100 |
6. Patient sex | 100 |
7. Patient race | 31 |
8. Patient location | 99 |
9. Patient social security Number | 100 |
10. Active medication list | 99 |
11. Allergies | 45 |
12. Code Status | 25 |
13. Admission date | 0.01 |
Coding categories for extracted physician note | |
14. Assessment of the patient's presentation (e.g., reason for hospitalization, clinical judgment) | 7 |
15. Active problem list | 92 |
16. Past medical history (Long term illnesses, e.g., hypertension, CHF, DM, COPD, CKD, cirrhosis, hyper/hypothyroidism, CAD) | 84 |
17. Venous/instrumentation access | 3 |
18. Pertinent Laboratory data | 62 |
19. Tests | 49 |
20. Short-term concerns (e.g., concerns for the next 18–24 hours and a recommended course of action, “to do” lists) | 93 |
21. Long-term plan (e.g., “patient may leave this afternoon if he has a ride” or “discharge to nursing home” or “how many days expected to be hospitalized”) | 20 |
22. Psychosocial concerns (e.g., which family members are present) | 10 |
CHF = congestive heart failure; DM = diabetes mellitus; COPD = congestive obstructive pulmonary disease; CKD = chronic kidney disease; CAD = coronary artery disease.
Note: for each category, the information was coded as either present 1 or absent (0).