Assessing the use of unstructured electronic health record data to identify exposure to firearm violence

Research on firearm violence is largely limited to people who experienced acute bodily trauma and death which is readily gathered from Inpatient and Emergency Department settings and mortality data. Exposures to firearm violence, such as witnessing firearm violence or losing a loved one to firearm violence, are not routinely collected in health care. As a result, the true public health burden of firearm violence is underestimated. Clinical notes from electronic health records (EHRs) are a promising source of data that may expand our understanding of the impact of firearm violence on health. Pilot work was conducted on a sample of clinical notes to assess how firearm terms present in unstructured clinical notes as part of a larger initiative to develop a natural language processing (NLP) model to identify firearm exposure and injury in ambulatory care data.

We used EHR data from 2012 to 2022 from a large multistate network of primary care and behavioral health clinics. A text string search of broad, gun-only, and shooting terms was applied to 9,598 patients with either/both an ICD-10 or an OCHIN-developed structured data field indicating exposure to firearm violence. A sample of clinical notes from 90 patients was reviewed to ascertain the meaning of terms.

Among the 90 clinical patient notes, 13 (14%) notes reflect documentation of exposure to firearm violence or injury from firearms. Results from this study identified refinements that should be considered for NLP text classification.

Unstructured clinical notes from primary and behavioral health clinics have potential to expand understanding of firearm violence.