The following is the summary of “Feasibility of establishing a multi-center research database using the electronic health record: The PURSUIT network” published in the December 2022 issue of Pediatric urology by Vemulakonda, et al.
In pediatric urology, multi-center studies are needed, yet disparities in physician documentation and research resources make it difficult for specialists to work together. One possible solution to this problem is the use of electronic health record (EHR) software. Evaluate the precision, completeness, and use of structured data pieces in a variety of medical settings. Clinic visits for patients diagnosed with congenital hydronephrosis and/or vesicoureteral reflux are now being recorded in accordance with a common template used across five academic pediatric urology practices. A protected database was created by compiling information from the template’s standard elements and from preexisting EHR fields. At sites with more than 100 charts, a random sample of 20% of babies with data from structured elements between 1/1/2020 and 4/30/2021 was identified and compared to human chart assessment.
Clinic and operation notes, orders related to the clinic contact, radiological data, and active medications were all included in the standardized manual chart review. The percentage of agreement and the kappa statistic was used to determine how well the data had been extracted. Early adopter sites (those who used the templates before 6/1/2019) used standardized reporting methodologies to compile a list of eligible patients who had their first clinic visit between January 1, 2020 and July 27, 2020. This list was then verified through a manual chart review. Next, we determined how often doctors used the letter template by comparing patients whose information matched that in the template to a list of potential candidates. The study included 230 patient records that met all of the required requirements. Over 85 % of extracted data from the EHR was in agreement with the manual chart review. About 10–15% of patients were misclassified based on race, ethnicity, or insurance data due to discrepancies in how these fields were coded from site to site. Only one in 10 renal ultrasounds were correctly labeled, and this was attributed to the presence of pictures from elsewhere that were noted in the radiology reports but absent from the clinical remark. When compared to every other data point, this one has a confidence level of 90% or higher.
The early adopters had a template utilization rate of 75% or higher (75% to 87.5%). This study is the first in urology to show how structured data pieces can facilitate research involving many institutions. The study is limited in that it only includes academic institutions using the Epic EHR, and it needs more information on utilization and sustainability from institutions with a background in using organized templates. Using EHR-based data gathering technologies enables multi-center research collaboration with generally high accuracy compared to manual chart review. There is a correlation between the length of time a site has used templates and the number of providers they employ.
Source: sciencedirect.com/science/article/abs/pii/S1477513122001978
