title: From patient care to research: a validation study examining the factors contributing to data quality in a primary care electronic medical record database.
abstract: BACKGROUND
  Electronic Medical Records (EMRs) are increasingly used in the provision of primary care and have been compiled into databases which can be utilized for surveillance, research and informing practice. The primary purpose of these records is for the provision of individual patient care; validation and examination of underlying limitations is crucial for use for research and data quality improvement. This study examines and describes the validity of chronic disease case definition algorithms and factors affecting data quality in a primary care EMR database.
  
  
  METHODS
  A retrospective chart audit of an age stratified random sample was used to validate and examine diagnostic algorithms applied to EMR data from the Manitoba Primary Care Research Network (MaPCReN), part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The presence of diabetes, hypertension, depression, osteoarthritis and chronic obstructive pulmonary disease (COPD) was determined by review of the medical record and compared to algorithm identified cases to identify discrepancies and describe the underlying contributing factors.
  
  
  RESULTS
  The algorithm for diabetes had high sensitivity, specificity and positive predictive value (PPV) with all scores being over 90%. Specificities of the algorithms were greater than 90% for all conditions except for hypertension at 79.2%. The largest deficits in algorithm performance included poor PPV for COPD at 36.7% and limited sensitivity for COPD, depression and osteoarthritis at 72.0%, 73.3% and 63.2% respectively. Main sources of discrepancy included missing coding, alternative coding, inappropriate diagnosis detection based on medications used for alternate indications, inappropriate exclusion due to comorbidity and loss of data.
  
  
  CONCLUSIONS
  Comparison to medical chart review shows that at MaPCReN the CPCSSN case finding algorithms are valid with a few limitations. This study provides the basis for the validated data to be utilized for research and informs users of its limitations. Analysis of underlying discrepancies provides the ability to improve algorithm performance and facilitate improved data quality.
authors: Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada. umcoleman@myumanitoba.ca.
authors: Nathan
authors: N
authors: Coleman
authors: Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada. Gayle.Halas@med.umanitoba.ca.
authors: Gayle
authors: G
authors: Halas
authors: Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada. William.Peeler@med.umanitoba.ca.
authors: William
authors: W
authors: Peeler
authors: Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada. nats_oh@gmail.com.
authors: Natalie
authors: N
authors: Casaclang
authors: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. tyler.williamson@ucalgary.ca.
authors: Tyler
authors: T
authors: Williamson
authors: Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada. Alan_Katz@cpe.umanitoba.ca.|Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. Alan_Katz@cpe.umanitoba.ca.
authors: Alan
authors: A
authors: Katz
mesh_terms: D000465:Algorithms; D002908:Chronic Disease; D016208:Databases, Factual / Q000592:standards*; D003863:Depression; D057286:Electronic Health Records / Q000592:standards*; D006801:Humans; D006973:Hypertension; D038801:International Classification of Diseases; D010003:Osteoarthritis; D011320:Primary Health Care / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
references: Int J Med Inform. 2011 Jul;80(7):533-40
references: 21514880
references: Can Fam Physician. 2012 Jul;58(7):804, e421-2
references: 22798469
references: Qual Prim Care. 2011;19(3):175-81
references: 21781433
references: Pharmacoepidemiol Drug Saf. 2009 Jan;18(1):7-15
references: 18980206
references: PLoS Med. 2011;8(1):e1000387
references: 21267058
references: J Am Med Inform Assoc. 2014 Mar-Apr;21(2):292-8
references: 24272162
references: BMC Fam Pract. 2012;13:7
references: 22335900
references: Med Hypotheses. 2012 Apr;78(4):471-4
references: 22305707
references: Popul Health Manag. 2010 Jun;13(3):139-50
references: 20568974
references: Clin Cornerstone. 1999;2(2):26-37
references: 10689542
references: Pharmacoepidemiol Drug Saf. 2011 Mar;20(3):321-4
references: 21351316
references: Can Respir J. 2001 Nov-Dec;8(6):421-6
references: 11753455
references: J Am Med Inform Assoc. 2002 Jul-Aug;9(4):395-401
references: 12087120
references: Perspect Health Inf Manag. 2012;9:1e
references: 22737097
references: BMJ. 2003 May 17;326(7398):1070
references: 12750210
references: Hippokratia. 2012 Jan;16(1):17-22
references: 23930052
references: Ann Fam Med. 2014 Jul;12(4):367-72
references: 25024246
references: Fam Pract. 2014 Apr;31(2):127-9
references: 24627543
references: J Am Board Fam Med. 2013 Mar-Apr;26(2):159-67
references: 23471929
references: Healthc Policy. 2009 Nov;5(2):26-39
references: 21037824
references: J Am Board Fam Med. 2009 Jul-Aug;22(4):412-22
references: 19587256
references: Br J Gen Pract. 2010 Mar;60(572):e128-36
references: 20202356
references: BMC Public Health. 2012;12:166
references: 22397597
references: Can Fam Physician. 2009 Sep;55(9):899
references: 19752259
references: BMC Fam Pract. 2013;14:55
references: 23641784
references: Inform Prim Care. 2006;14(2):133-7
references: 17059702
references: BMC Med Inform Decis Mak. 2010;10:23
references: 20416069