Electronic Medical Record Inaccuracies: Multicenter Analysis of Challenges with Modified Lung Cancer Screening Criteria.

Publication Title

Canadian respiratory journal : journal of the Canadian Thoracic Society

Authors

Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Carson C Fuller, Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Christopher R Gilbert, Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.Follow
John R Handy, Department of Thoracic Surgery, Providence Health and Services, Portland, OR, USA.Follow
Kimberly E Costas, Division of Thoracic Surgery, Providence Regional Medical Center, Everett, WashFollow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Eric Vallières, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Jed A Gorden, Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.Follow

Document Type

Article

Publication Date

1-1-2020

Abstract

The National Comprehensive Cancer Network expanded their lung cancer screening (LCS) criteria to comprise one additional clinical risk factor, including chronic obstructive pulmonary disease (COPD). The electronic medical record (EMR) is a source of clinical information that could identify high-risk populations for LCS, including a diagnosis of COPD; however, an unsubstantiated COPD diagnosis in the EMR may lead to inappropriate LCS referrals. We aimed to detect the prevalence of unsubstantiated COPD diagnosis in the EMR for LCS referrals, to determine the efficacy of utilizing the EMR as an accurate population-based eligibility screening "trigger" using modified clinical criteria. We performed a multicenter review of all individuals referred to three LCS programs from 2012 to 2015. Each individual's EMR was searched for COPD diagnostic terms and the presence of a diagnostic pulmonary functionality test (PFT). An unsubstantiated COPD diagnosis was defined by an individual's EMR containing a COPD term with no PFTs present, or the presence of PFTs without evidence of obstruction. A total of 2834 referred individuals were identified, of which 30% (840/2834) had a COPD term present in their EMR. Of these, 68% (571/840) were considered unsubstantiated diagnoses: 86% (489/571) due to absent PFTs and 14% (82/571) due to PFTs demonstrating no evidence of postbronchodilation obstruction. A large proportion of individuals referred for LCS may have an unsubstantiated COPD diagnosis within their EMR. Thus, utilizing the EMR as a population-based eligibility screening tool, employing expanded criteria, may lead to individuals being referred, potentially, inappropriately for LCS.

Area of Special Interest

Cancer

Specialty/Research Institute

Swedish Thoracic Surgery

Specialty/Research Institute

Oncology

Specialty/Research Institute

Health Information Technology

DOI

10.1155/2020/7142568