Imaging contrast allergies are poorly documented in EHRs

Documenting contrast allergies in the electronic health record (EHR) is central for safe imaging, but a new study found such records are incomplete, misleading and often ambiguous. A multidisciplinary approach may be needed to solve the problem.

The researchers identified more than 40,000 contrast allergy records associated with 49,000 reactions taken from a single institution’s EHR allergy repository for patients seen between 2000-2013. Overall, a known reaction was entered in 72 percent of cases, but 12 percent were non-allergic-like reactions.

A majority (69 percent) of contrast allergen records were low quality, containing ambiguous contrast terms. Nineteen percent of records were organized by imaging modality, with 82 percent of those tied to fluoroscopy or CT and 16 percent containing MRI. Diagnostic radiopharmaceuticals (1.4 percent) and ultrasonography contrast (0.1 percent) were the most uncommon. This could be due to low administered dose or low volumes of studies required using contrast agents, the researchers noted.

Additionally, more than one-fifth of reactions were entered as free text. There were more than 1,300 unique contrast terms organized into 141 concepts.

“We identified notable deficiencies in documentation quality for a diverse range of contrast agent allergies in the EHR of a large health care system over a 13-year period, supporting our hypothesis,” wrote Li Zhou, MD, PhD, of Brigham and Women’s Hospital in Massachusetts, and colleagues. “Most commonly, contrast allergen records were imprecise, representing concepts not specific to any imaging modality or chemical class.”

Addressing the problem

One reason for poor documentation, the authors wrote, may be because most records are not entered by the clinician who directly witnessed the reactions, but rather by those who received an oral history of reactions directly from patients.

An additional factor is the design of the EHR itself, which the authors suggested may not be tailored for entering contrast allergies. 

“Potential technologic solutions include expansion of standard terminologies informed by our contrast agent value set, as well as clinical decision support enhancements to the EHR such as dynamic pick lists that encourage higher-quality contrast allergy and reaction documentation,” the researchers wrote. “At the same time, for the variety of health care team members who document allergies, more allergy education and sharing of documentation best practices is needed.”

Not only is proper allergy documentation critical for patient care, but clearer notes may also reduce unnecessary interventions and ultimately create a more efficient system. It may be up to clinicians across varying specialties to address these issues.

“Those clinicians most familiar with contrast allergies—radiologists, allergists, radiologic technologists, and radiology nurses—should be encouraged to enhance, correct, and delete contrast-related entries in the EHR allergy section as appropriate,” the authors concluded. “A multidisciplinary effort is needed to provide optimal patient care.”

The full study was published March 4 in the Journal of the American College of Radiology.