title: The validation of electronic health records in accurately identifying patients eligible for colorectal cancer screening in safety net clinics.
abstract: While electronic health records (EHRs) play a key role in increasing colorectal cancer (CRC) screening by identifying individuals who are overdue, important shortfalls remain.
  
  
  
  As part of the Strategies and Opportunities to STOP Colon Cancer (STOP CRC) study, we assessed the accuracy of EHR codes in identifying patients eligible for CRC screening.
  
  
  
  We selected a stratified random sample of 800 study participants from 26 participating clinics, in the Pacific Northwest region of the USA. We compared data obtained through codes in the EHR to conduct a manual chart audit. A trained chart abstractor completed the abstraction of eligible and ineligible patients.
  
  
  
  Of 520 individuals in need of CRC screening, identified via the EHR, 459 were confirmed through chart review (positive predictive value = 88%). Of 280 individuals flagged as up-to-date in their screening per EHR data, 269 were confirmed through chart review (negative predictive value = 96%). Among the 61 patients incorrectly classified as eligible, 83.6% of disagreements were due to evidence of a prior colonoscopy or referral that was not captured in recognizable fields in the EHR.
  
  
  
  Our findings highlight importance of better capture of past screening events in the EHR. While the need for better population-based data is not unique to CRC screening, it provides an important example of the use of population-based data not only for tracking care, but also for delivering interventions.
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, amanda.f.petrik@kpchr.org.
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Petrik
authors.affiliation: Group Health Research Institute, Seattle, WA and.
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Green
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.affiliation: OCHIN, Portland, OR, USA.
authors.forename: Thuy
authors.initials: T
authors.lastname: Le
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bachman
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Erin
authors.initials: E
authors.lastname: Keast
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rivelli
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Gloria D
authors.initials: GD
authors.lastname: Coronado
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D057286:Electronic Health Records / Q000592:standards; D006801:Humans; D008875:Middle Aged; D015205:Northwestern United States; D018579:Patient Selection; D011237:Predictive Value of Tests; D064876:Safety-net Providers
keywords: Colorectal cancer; community medicine; electronic health record; gastroenterology; screening.