Validation of Colorectal Cancer Screening in the Electronic Health Record for Identifying Patients Due for Screening in a Pragmatic Trial
validation, electronic health record
Background/Aims: In 2015 an estimated 143,000 adults in the United States will be diagnosed with colorectal cancer, and 52,000 will die from the disease. Despite this knowledge, colorectal cancer screening rates remain low. Electronic health records (EHR) hold much promise for helping to close this gap by identifying eligible individuals who are overdue for or have never completed colorectal cancer screening; however, important shortfalls to this approach remain. Records of colonoscopy completion are frequently missing in the EHR. Variation in workflow and documentation can lead to incomplete capture of colorectal cancer screening and testing events. Through the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) study, we conducted a data validation to understand the data being captured in the EHR and completeness of the data.
Methods: We selected a stratified random sample of 800 study participants from 26 participating clinics to compare the EHR to chart audit data. A trained validation specialist completed the abstraction qualifying data of eligible and ineligible patients.
Results: Comparing EHR data to chart audits, we found 88% (459/520) of individuals were correctly classified as eligible for program inclusion. EHR data correctly identified 96% (269/280) of excluded patients. Of the patients incorrectly classified as eligible, 83.6% (51/61) of disagreements were due to evidence of a prior colonoscopy or referral that was not captured in recognizable fields in the EHR.
Conclusion: If our goal to increase CRC screening uptake is achieved, there will be an even greater need to improve data capture of all screening events, document completion of diagnostic testing after a positive test, conduct surveillance exams and provide appropriate outreach to patients needing repeated screening. While the need for better population-based data is not unique to CRC screening, it provides an important example of using population-based data for not only tracking needed care but also directly delivering needed interventions.
Petrik AF, Green B, Vollmer W, Let T, Bachman B, Keast E, Coronado G. Validation of colorectal cancer screening in the electronic health record for identifying patients due for screening in a pragmatic trial. J Patient Cent Res Rev. 2016;3:180.