title: Computer-facilitated review of electronic medical records reliably identifies emergency department interventions in older adults.
abstract: OBJECTIVE
  An estimated 14% to 25% of all scientific studies in peer-reviewed emergency medicine (EM) journals are medical records reviews. The majority of the chart reviews in these studies are performed manually, a process that is both time-consuming and error-prone. Computer-based text search engines have the potential to enhance chart reviews of electronic emergency department (ED) medical records. The authors compared the efficiency and accuracy of a computer-facilitated medical record review of ED clinical records of geriatric patients with a traditional manual review of the same data and describe the process by which this computer-facilitated review was completed.
  
  
  METHODS
  Clinical data from consecutive ED patients age 65 years or older were collected retrospectively by manual and computer-facilitated medical record review. The frequency of three significant ED interventions in older adults was determined using each method. Performance characteristics of each search method, including sensitivity and positive predictive value, were determined, and the overall sensitivities of the two search methods were compared using McNemar's test.
  
  
  RESULTS
  For 665 patient visits, there were 49 (7.4%) Foley catheters placed, 36 (5.4%) sedative medications administered, and 15 (2.3%) patients who received positive pressure ventilation. The computer-facilitated review identified more of the targeted procedures (99 of 100, 99%), compared to manual review (74 of 100 procedures, 74%; p < 0.0001).
  
  
  CONCLUSIONS
  A practical, non-resource-intensive, computer-facilitated free-text medical record review was completed and was more efficient and accurate than manually reviewing ED records.
authors.affiliation: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kbiese@med.unc.edu
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Biese
authors.forename: Cory R
authors.initials: CR
authors.lastname: Forbach
authors.forename: Richard P
authors.initials: RP
authors.lastname: Medlin
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Scholer
authors.forename: Brenda
authors.initials: B
authors.lastname: McCall
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Michael
authors.initials: M
authors.lastname: LaMantia
authors.forename: Cherri
authors.initials: C
authors.lastname: Hobgood
authors.forename: J S
authors.initials: JS
authors.lastname: Kizer
authors.forename: Jan
authors.initials: J
authors.lastname: Busby-Whitehead
authors.forename: Charles B
authors.initials: CB
authors.lastname: Cairns
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D009716:Numerical Analysis, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies