A first step towards translating evidence into practice: heart failure in a community practice-based research network.
OBJECTIVE
To determine the validity of an electronic health record (EHR) in the identification of patients with left ventricular dysfunction in a primary care setting.


METHODS
A cross-sectional study.


METHODS
Nine clinics participating from the Providence Research Network (PRN) comprising 75 physicians serving approximately 200,000 patients. All clinics utilise the Logician EHR for all patient care activities.


METHODS
The study included all PRN patients with an active chart.


METHODS
All patients with a heart failure diagnosis in the problem list were identified by database query. Left ventricular ejection fraction (LVEF) data were identified through query of local cardiology and hospital echocardiography databases. Additional LVEF data were sought in a manual search of paper charts.


RESULTS
To determine the problem list coding accuracy for a heart failure (HF) diagnosis we evaluated sensitivity, positive predictive value and related derived statistical measures using documented LVEF as the 'gold standard'. Of 205 755 active PRN patients, 1731 were identified with a problem list entry of HF. Based on comparison with documented LVEF, the sensitivity for problem list entry was 43.9% and 54.4% when HF was defined as an LVEF < or = 55% and < or = 40%, respectively.


CONCLUSIONS
The validity of an EHR problem list entry of HF was poor. The problem list validity could be enhanced through reconciliation with other data sources. Inaccurate EHR problem lists may have clinical consequences, including underprescribing of beneficial therapies.
Onofrei
Mihai
M
Providence Health System, Portland, Oregon, USA.
Hunt
Jacquelyn
J
Siemienczuk
Joseph
J
Touchette
Daniel R
DR
Middleton
Blackford
B
D003430:Cross-Sectional Studies; D006801:Humans; D038801:International Classification of Diseases; D016347:Medical Records Systems, Computerized / Q000458:organization & administration* / Q000592:standards; D009922:Oregon; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000145:classification* / Q000175:diagnosis