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.