Strengths and challenges of using electronic medical records to identify patients overdue for cervical cancer screening: Coordinating care, provider usage, and data extractability
BACKGROUND: Cervical cancer screening is one of the most important preventative health measures for women aged 21 to 64, but accurate electronic medical record documentation of screening history and contraindications can pose challenges for calculating both patient-level and facility-level screening metrics, particularly when coordinating between outside gynecologists and primary care physicians. OBJECTIVES: To understand true cervical cancer screening rates at an urban New England community health center. To develop a more accurate and efficient method for identifying patients overdue for a Pap test. METHODS: A combined manual and automated audit of all HIV-negative patients with a cervix aged 21-64 who received their primary care at Fenway Health Center in 2012. RESULTS: Out of 5,281 eligible patients, 55.7%(n=2942) had a Pap lab report or documentation of a Pap test in the last 3 years. On closer manual review, 8.0%(n=186) of the remaining 44.3%(n=2339) of patients who were thought to be overdue were actually medically inappropriate for Pap testing due to factors such as male-to-female transgender status or having undergone a hysterectomy. An additional 35.5%(n=764) of these patients also had documentation of a Pap in freetext fields such as past medical history or visit notes that was not being detected by data queries. CONCLUSIONS: Rather than a 55.7% rate of cervical cancer screening, Fenway Health had a 75.5% screening rate that was not being accurately assessed due to failure to capture the information in the EMR in a systematic way that was accessible by data queries. Efforts to record important information such as lack of a cervix or patient-reported Pap history in discrete fields amenable to data collection and analysis are critical for health centers to understand and accurately report their screening rates.
Communication and informatics
Describe challenges in capturing and recording data in electronic medical record systems that lead to underestimation of cervical cancer screening rates. Discuss potential solutions to these challenges.
Keyword(s): Cancer Screening, Data Collection
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I have been the study coordinator, data manager, and data analyst for multiple studies on a variety of health topics. Among my scientific interests has been the health of women, particularly underserved subpopulations.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.