CAM documentation in clinical notes Towards an automated surveillance system for drug-herb interactions

Herbal dietary supplements are the most popular form of complementary and alternative medicine (CAM) therapy — they are used by over 38 million US adults. However, treatments involving dietary supplements could potentially interact with prescription medications and have a negative impact on patient outcomes. Despite safety concerns, previous studies indicate that most patients do not discuss CAM use with their physicians. In this preliminary study we set out to: (1) conduct a computer assisted chart review of notes from multiple sclerosis (MS) patients to identify the documentation level of CAM use; and (2) investigate whether any herbal supplement in the resulting list is known to have a negative interaction with prescription drugs commonly taken by MS patients. The outcomes of this study will be used to inform the design of a system to collect CAM information from both patients and physician notes and issue alerts for potential negative interactions. Five percent of the analyzed notes contained descriptions of CAM use, 63% of which were Biologically-Based Practices. The notes containing actual mentions of CAM represent a small percentage when compared with the number reported by studies that obtained their data directly from patients. These numbers indicate that the use of CAM is indeed underreported in patient notes. Among the 19 types of herbs which use was positively identified, four had moderate interactions and one had minor interactions with commonly prescribed MS medications. Our findings suggest the need to collect more accurate data on CAM use in order to provide adequate surveillance of drug-herb interactions