Summary
Background
Although multi-center research is needed in pediatric urology, collaboration is impeded
by differences in physician documentation and research resources. Electronic health
record (EHR) tools offer a promising avenue to overcome these barriers.
Objective
To assess the accuracy, completeness, and utilization of structured data elements
across multiple practices.
Study design
A standardized template was developed and implemented at five academic pediatric urology
practices to document clinic visits for patients with congenital hydronephrosis and/or
vesicoureteral reflux. Data from standardized elements in the template and from pre-existing
EHR fields were extracted into a secure database. A 20% random sample of infants with
data from structured elements from 1/1/2020 and 4/30/2021 were identified and compared
to manual chart review at sites with >100 charts; all other sites reviewed at least
20 charts. Manual chart review was standardized across sites and included: clinic
and operative notes, orders linked to the clinic encounter, radiology results, and
active medications. Accuracy of data extraction was evaluated by computing the kappa
statistic and percentage agreement. For sites that had adopted the templates prior
to 6/1/2019 (early adopters), a list of eligible patients with an initial clinic visit
from 1/1/2020–7/27/2020 was generated using standardized reporting techniques and
confirmed by manual chart review. Physician utilization of the template was then calculated
by comparing patients with data obtained from the note template to the generated list
of eligible patients.
Results
230 patient records met study criteria. Agreement between manual chart review and
data extracted from the EHR was high (>85%). Race, ethnicity and insurance data were
misclassified in about 10–15% of cases; this was due to site-specific differences
in how these fields were coded. Renal ultrasound was misclassified 12% of the time;
this was primarily due to outside images documented in radiology results but not included
in the clinical note. All other data elements had >90% agreement (Figure). Template
utilization for early adopters was >75% (75.5–87.5%).
Discussion
This is the first study in urology to demonstrate that use of structured data elements
can support multi-center research. Limitations include: inclusion of only academic
sites with the Epic EHR and lack of data on utilization and sustainability at sites
without a prior history of structured template use.
Conclusions
Graphical AbstractAgreement between EHR-based data capture and manual chart review.
Keywords
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References
- Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology.J Urol. 1998 Jan; 159 (PMID: 9400485): 222-228
- The challenges faced in the design, conduct and analysis of surgical randomised controlled trials.Trials. 2009; 10: 9https://doi.org/10.1186/1745-6215-10-9
- Electronic health records and ambulatory quality of care.J Gen Intern Med. 2013; 28: 496-503
- Electronic health record-based decision support to improve asthma care: a cluster-randomized trial.Pediatrics. 2010; 125: e770-e777
- Sustainability considerations for health research and analytic data infrastructures.EGEMS (Washington, DC). 2014; 2: 1113
- Comparative effectiveness research: policy context, methods development and research infrastructure.Stat Med. 2010; 29: 1963-1976
- Pragmatic (trial) informatics: a perspective from the NIH Health Care Systems Research Collaboratory.J Am Med Inform Assoc. 2017; 24: 996-1001
- Electronic clinical laboratory test results data tables: lessons from mini-sentinel.Pharmacoepidemiol Drug Saf. 2014; 23: 609-618
- Feasibility of integrating research data collection into routine clinical practice using the electronic health record.J Urol. 2014; 192: 1215-1220
- “Minimally invasive research?” Use of the electronic health record to facilitate research in pediatric urology.J Pediatr Urol. 2018 Oct; 14 (Epub 2018 Jun 9. PMID: 29929853; PMCID: PMC6286872): 374-381https://doi.org/10.1016/j.jpurol.2018.04.033
- SAS/STAT® 15.1 user's guide.SAS Institute Inc, Cary, NC2018
- Pragmatic (trial) informatics: a perspective from the NIH health care systems research collaboratory.J Am Med Inform Assoc. September 2017; 24: 996-1001https://doi.org/10.1093/jamia/ocx016
- Electronic health records to facilitate clinical research.Clin Res Cardiol. 2017 Jan; 106 (Epub 2016 Aug 24. PMID: 27557678; PMCID: PMC5226988): 1-9https://doi.org/10.1007/s00392-016-1025-6
- Variations in adherence to AUA guidelines for follow up of children with vesicoureteral reflux.Urol Pract. November 2019; (UP-19-97R1. Accepted for publication)
- Implementation science in perioperative care.Anesthesiol Clin. 2018 Mar; 36 (PMID: 29425593; PMCID: PMC5828037): 1-15https://doi.org/10.1016/j.anclin.2017.10.004
- Implementation mapping: using intervention mapping to develop implementation strategies.Front Public Health. 2019 Jun 18; 7 (PMID: 31275915; PMCID: PMC6592155): 158https://doi.org/10.3389/fpubh.2019.00158
- Obtaining data from electronic health records.in: Gliklich R.E. Leavy M.B. Dreyer N.A. Tools and technologies for registry interoperability, registries for evaluating patient outcomes: a user’s guide, 3rd ed., Addendum 2 [Internet]. Agency for Healthcare Research and Quality (US), Rockville (MD)2019 Oct (Chapter 4)
- Integrating research data capture into the electronic health record workflow: real-world experience to advance innovation.Perspect Health Inf Manag. October 2014; (Fall)
- Use of more than one electronic medical record system within a single health care organization.Appl Clin Inform. 2012; 3 (Published 2012 Dec 12): 462-474
- Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network.Int Urol Nephrol. 2021 Aug; 53 (Epub 2021 May 4. PMID: 33948809; PMCID: PMC8282718): 1485-1495https://doi.org/10.1007/s11255-021-02866-y
Article info
Publication history
Published online: May 13, 2022
Accepted:
May 6,
2022
Received in revised form:
April 21,
2022
Received:
February 2,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
