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Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
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©2013 the author(s)
open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
collection publication date: Year: 2013
Volume: 5E-location ID: e159
Publisher Id: ojphi-05-159

An Algorithm That Identifies Coronary and Heart Failure Events In The Electronic Health Record
Jawali Jaranilla*1
Thomas E. Kottke1
Courtney J. Baechler2
1Health Partners Institute for Education and Research, Minneapolis, MN, USA;
2University of Minnesota, Minneapolis, MN, USA
*Jawali Jaranilla, E-mail:


The objective of this project was to identify criteria that accurately categorize acute coronary and heart failure events exclusively with electronic health record data so that the medical record can be used for surveillance without manual record review.


Surveillance to track the incidence, prevalence and treatment of disease is a fundamental task of public health. The advent of universal health care coverage in the United States and electronic health records could make the medical record a valuable disease surveillance tool. This can only happen, however, if the necessary data can be extracted from the medical record without manual review.


We serially compared 3 different computer algorithms to manual record review. The first two algorithms relied on ICD9CM codes, troponin levels, ECG data and echocardiographic data. The 3rd algorithm relied on a very detailed coding system, IMO statements, troponin levels and echocardiographic data.


Cohen’s Kappa for the initial algorithm was 0.47 (95%CI 0.41–0.54). Cohen’s Kappa was 0.61 (95%CI 0.55–0.68) for the second algorithm. Cohen’s Kappa for the third algorithm was 0.99 (95%CI 0.98–1.00).


We conclude that electronic medical record data are sufficient to categorize coronary heart disease and heart failure events without manual record review. However, only moderate agreement with medical record review can be achieved when the classification is based on 4-digit ICD9CM codes because ICD9CM 410.9 includes myocardial infarction with ST elevation (STEMI) and myocardial infarction without ST elevation (nSTEMI). Nearly perfect agreement can be achieved using IMO statements, a more detailed coding system that tracks to ICD9, ICD10 and SnoMED-CT. IMO statements are available in many electronic medical record systems.


Funding provided by the following: The HealthPartners Research Foundation (a partnership grant to TEK); The Heart Disease and Stroke Prevention Unit at the Minnesota Department of Health from a Capacity Building - Cooperative Agreement grant from the Centers for Disease Control and Prevention CDC) 5U50DP000721-04; and, NIH training grant T32 HL69764 (supporting CJB).

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: validity, surveillance, coronary artery disease, heart failure, electronic medical record.