title: Use of an electronic medical record "dotphrase" data template for a prospective head injury study.
abstract: BACKGROUND
  The adoption of electronic medical records (EMRs) in emergency departments (EDs) has changed the way that healthcare information is collected, charted, and stored. A challenge for researchers is to determine how EMRs may be leveraged to facilitate study data collection efforts. Our objective is to describe the use of a unique data collection system leveraging EMR technology and to compare data entry error rates to traditional paper data collection.
  
  
  METHODS
  This was a retrospective review of data collection methods during a multicenter study of ED, anti-coagulated, head injury patients. On-shift physicians at 4 centers enrolled patients and prospectively completed data forms. These physicians had the option of completing a paper data form or an electronic "dotphrase" (DP) data form. A feature of our Epic®-based EMR is the ability to use DPs to assist in medical information entry. A DP is a preset template that may be inserted into the EMR when the physician types a period followed by a code phrase (in this case ".ichstudy"). Once the study DP was inserted at the bottom of the electronic ED note, it prompted enrolling physicians to answer study questions. Investigators then extracted data directly from the EMR.
  
  
  RESULTS
  From July 2009 through December 2010, we enrolled 883 patients. DP data forms were used in 288 (32.6%; 95% confidence interval [CI] 29.5, 35.7%) cases and paper data forms in 595 (67.4%; 95% CI 64.3, 70.5%). Sixty-six (43.7%; 95% CI 35.8, 51.6%) of 151 physicians enrolling patients used DP data entry at least once. Using multivariate analysis, we found no association between physician age, gender, or tenure and DP use. Data entry errors were more likely on paper forms (234/595, 39.3%; 95% CI 35.4, 43.3%) than DP forms (19/288, 6.6%; 95% CI 3.7, 9.5%), difference in error rates 32.7% (95% CI 27.9, 37.6%, P < 0.001).
  
  
  CONCLUSIONS
  DP data collection is a feasible means of data collection. DP data forms maintain all study data within the secure EMR environment, obviating the need to maintain and collect paper data forms. This innovation was embraced by many of our emergency physicians and resulted in lower data entry error rates.
authors.affiliation: Kaiser Permanente South Sacramento, Department of Emergency Medicine, Sacramento, California.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Offerman
authors.forename: Adina S
authors.initials: AS
authors.lastname: Rauchwerger
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Ballard
authors.forename: Uli K
authors.initials: UK
authors.lastname: Chettipally
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.forename: Mary E
authors.initials: ME
authors.lastname: Reed
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes