Gastrointestinal
Electronic medical record: research tool for pancreatic cancer?

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Abstract

Background

A novel data warehouse based on automated retrieval from an institutional health care information system (HIS) was made available to be compared with a traditional prospectively maintained surgical database.

Methods

A newly established institutional data warehouse at a single-institution academic medical center autopopulated by HIS was queried for International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes for pancreatic neoplasm. Patients with ICD-9-CM diagnosis codes for pancreatic neoplasm were captured. A parallel query was performed using a prospective database populated by manual entry. Duplicated patients and those unique to either data set were identified. All patients were manually reviewed to determine the accuracy of diagnosis.

Results

A total of 1107 patients were identified from the HIS-linked data set with pancreatic neoplasm from 1999–2009. Of these, 254 (22.9%) patients were also captured by the surgical database, whereas 853 (77.1%) patients were only in the HIS-linked data set. Manual review of the HIS-only group demonstrated that 45.0% of patients were without identifiable pancreatic pathology, suggesting erroneous capture, whereas 36.3% of patients were consistent with pancreatic neoplasm and 18.7% with other pancreatic pathology. Of the 394 patients identified by the surgical database, 254 (64.5%) patients were captured by HIS, whereas 140 (35.5%) patients were not. Manual review of patients only captured by the surgical database demonstrated 85.9% with pancreatic neoplasm and 14.1% with other pancreatic pathology. Finally, review of the 254 patient overlap demonstrated that 80.3% of patients had pancreatic neoplasm and 19.7% had other pancreatic pathology.

Conclusions

These results suggest that cautious interpretation of administrative data rely only on ICD-9-CM diagnosis codes and clinical correlation through previously validated mechanisms.

Introduction

Electronic medical records are becoming progressively more important for both clinical care and research. In the current era, data warehouses and repositories have been established to serve the dual function of patient care and investigation. In theory, medical data warehouses may facilitate clinical research, including assessing and improving quality and outcomes.

Currently, outcomes and health services research can be based on a number of different data sources, including individual, department, or institutional databases; patient registries; administrative databases; and, more recently, data warehouses. All these have their own respective advantages and disadvantages. Large national databases, including the National Surgical Quality Improvement Program and the Nationwide Inpatient Sample, share some common ground with data warehouses as they are in part based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding. Recently, at our institution, a newly established health care information system (HIS) data warehouse was established and made available to pilot investigators [1], [2].

Large computerized health care system databases have been touted as the research tools of the future [1], [3], [4]. However, manually maintained departmental databases still exist. Our research group, Surgical Outcomes Analysis & Research, has previously analyzed different types of data resources [5], [6]. Manasanch et al. [6], [7] demonstrated that a significant number of pancreatic neuroendocrine tumors are missed via tumor registry's use of ICD-9-CM diagnosis codes [6], [7]. Other previous studies have analyzed the effectiveness of data collection systems, such as tumor registries with varying results [8], [9], [10], [11]. The aim of the present study was to determine whether clinical research could be facilitated using a novel data warehouse, using pancreatic cancer as a model.

Section snippets

HIS-linked database

Encrypted records from a newly developed HIS-linked institutional clinical data warehouse, capturing inpatient and outpatient clinical and billing information from a pool of 2.05 million patients evaluated at an academic medical institution and its affiliates since 1995, were queried. This database, still currently under development, allows investigators to use a web-based query tool to determine the aggregate total number of patients at network hospitals who meet a given set of inclusion and

Results

From an initial HIS-linked database of 2.05 million patients and 121 million data points, 1198 were identified using our search query for pancreatic neoplasm. This number was subsequently winnowed to 1107 patients on limiting to the years 1999–2009. Along the same period, 444 patients were identified in the prospectively maintained surgical database. This was subsequently narrowed to 394 patients with pancreatic neoplasm over the years 1999–2009 (Fig. 1).

Of the 1107 HIS-linked patients, 254

Discussion

Analysis of a promising new institutional data warehouse, using pancreatic neoplasm as a prototype query, has demonstrated that 45.0% of patients from the HIS-linked database presumed to have pancreatic malignancy and not to have any identifiable pancreatic pathology. Additionally, 18.7% of patients resulting from that query were found to have non-neoplastic pancreatic pathology on meticulous manual review. Furthermore, 35.5% of all patients with pathologic documentation of pancreatic neoplasm

Acknowledgment

This work was supported by American Cancer Society (MRSG-10-003), a Howard Hughes Early Career Award (NIH 1 UL1RR031982), and Pancreatic Cancer Alliance.

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