Extracting data from an incrementally implemented electronic health record system: Lessons learned from tracking colorectal cancer screening at a community health center

Background: Electronic Health Records (EHR) has the potential to provide information for researchers to design targeted strategies to reduce cancer disparities experienced by many minority groups. To realize these potential benefits, health data must be accurately transferred from paper charts to electronic health records.

Objective: We present lessons learned from retrieving colorectal cancer screening data on age-eligible clinic patients (men and women of Vietnamese ethnicity) from an EHR system that was incrementally implemented by a community health center. Data on FOBT, colonoscopy, and sigmoidoscopy, including screening intervals, were extracted based on USPTF guidelines. An extraction protocol was developed to guide staff in the clinic's data services unit.

Results: Incremental implementation of EHR systems enables a smoother transition and the least negative impact on clinic operations and patient care. However, updating preventive health care data is usually not a top priority. The quality of screening information can potentially be compromised in the transition from paper to paperless due to incomplete or incorrect transfer of screening history; lack of coordination and continuity in the transition; staff discomfort with the implementation process and use of information technologies; financial constraints; and inconsistent methods in which screening data are categorized and defined.

Discussion: To maintain the integrity of patients' cancer screening history during data extraction, it is important to understand the capacity of EHR, to identify the most appropriate approaches to obtaining data, and to define data parameters. Auditing charts after extraction may help to locate unintentional errors that occurred in the adoption process.