B61 MANAGING LUNG CANCER SCREENING AND ITS DOWNSTREAM FINDINGS: Electronic Medical Record Inaccuracies: A Challenge For Population Based Lung Cancer Screening

Publication Title

American Journal of Respiratory and Critical Care Medicine

Document Type

Conference Proceeding

Publication Date

5-18-2015

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Rationale The 2015 National Comprehensive Cancer Network (NCCN) relaxed the United States Preventive Services Task Force (USPSTF) criteria for lung cancer screening to age >50, 20 pack year history of smoking and one additional risk factor which includes history of chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis. Emphysema and chronic bronchitis are examples of common pulmonary diagnosis often interchanged with COPD. The electronic medical record (EMR) is the principle source of patient information and is used to identify both individuals and populations for lung cancer screening. Our hypothesis is that some patients are misdiagnosed as having COPD in the EMR, which would lead to inappropriate referrals and possibly inappropriate screening. Methods We performed a retrospective review from 2012-2015 of all patients referred to the Swedish Cancer Institute, Lung Cancer Screening Program who met USPSTF screening criteria. The patient’s EMR was searched for the diagnostic terms ‘COPD, emphysema, chronic bronchitis and chronic airway obstruction’, and the presence of airflow obstruction on pulmonary function tests (PFT). The location that the terms appeared and the title of the person who entered the term were recorded. The terms ‘emphysema’ and ‘chronic bronchitis’ where included in the analysis because they are common substitutions for COPD. A misdiagnosis was defined as a patient having a diagnosis of COPD in their EMR without identified diagnostic PFTs. Results We identified 226 patients. When excluding the terms ‘emphysema’ and ‘chronic bronchitis’, a diagnosis of COPD without confirmatory PFTs appeared in patient’s EMR in 9% (20/226) of cases (Table). The misdiagnosis appeared first in the Problem List in 90% (18/20) of patients, with the majority being entered by a Family Medicine Physician (65%, 13/20). Only 3 (1%) patient charts were identified to have the terms ‘emphysema’ and ‘chronic bronchitis’. All were noted in Problem List and all were entered by a Family Medicine Physician. Combining all the terms the total rate of misdiagnosis in the patient’s EMR would be 10%. Conclusions The rate of COPD misdiagnosis in the EMR is high. This will impact our current ability to use the EMR as a population based screening tool to identify patients who are at high risk and qualify for lung cancer screening using modified diagnosis based inclusion criteria. These inaccuracies could impact the efficacy and cost of lung cancer screening.

Clinical Institute

Cancer

Specialty

Health Information Technology

Specialty

Oncology

Specialty

Pulmonary Medicine

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