[MA 2023 31] Quantifying the value of accurate diagnosis data registration
Dutch Hospital Data / KIK / Santeon
Proposed by: Eva Klappe, PhD [e.klappe@dhd.nl]
Title: Quantifying the value of accurate diagnosis data registration
Place of the SRP Project:
Dutch Hospital Data / KIK / Santeon
Introduction
An Electronic Health Record (EHR) providing a clear overview of the patient’s problems is of vital importance1. Studies have shown that structured formats, such as electronic problem lists, can provide such overview as they have greater consistency. Without structured lists, problems are documented scattered, and often in free text, which may contribute to errors and inefficient information retrieval.
Previous research showed that in healthcare organizations increased usage of structured problem lists may be warranted for which policies should be developed2. In fact, correctly-structured problem lists lead to better and faster clinical decision-making. Moreover, to adopt the problem list in practice, the provider should (almost) immediately be rewarded for their registration effort3. For instance, when providers add diagnoses to a problem list, they can automatically request orders for that specific diagnosis. Or, when problem lists are up-to-date and complete, the problem lists could be automatically imported “with just one click” in the discharge or referral letters in the EHR system, reducing the additional registration effort to describe all diagnoses in the letters.
There is limited evidence that quantifies the impact of accurate or inaccurate problem lists to the workflow of a provider. Moreover, to understand problem list usage, it is essential that problem list data quality is investigated.
Description of the SRP Project/Problem:
This project addresses the need to explore problem list data quality and the need to quantify the added value of accurate data registration, specifically for the problem list.
Research questions
What are factors that cause poor problem list usage and what could improve problem list usage?
What is current problem list data quality in Dutch hospitals, in terms of completeness?
What is current problem list data quality in Dutch hospitals, in terms of accuracy?
What is the impact of problem list data quality on the workflow of the healthcare provider?
Expected results
Literature review of existing research on problem list usage, in terms of barriers and facilitating factors. This should be extended by a thorough evaluation of what providers perceive as a direct benefit of a correctly structured problem list.
Definition and assessment of current problem list data completeness in (a selection of) Dutch hospitals, including identification of which specialties have higher (problem list) data quality
Example: “on average, internal medicine specialists document 7 problems for patients older than 70, while surgeons document on average 3 problems for patients older than 70”
Identification and assessment of proxy’s with regards to problem list usage. Proxy’s can help identify problem list accuracy.
Example of proxy’s: “Of 100 patients who had ‘insulin’ in their medication list, only 50% also had diabetes on the problem list”
In case of the proxy’s or definition of problem list data quality, qualitative research is recommended, such as a focus group with IT-personnel, business intelligence specialists and healthcare providers who can identify the required proxy’s
Quantified evidence that problem list data quality results in an added value for the healthcare provider, outcome measures (such as time) are defined with quality indicators experts and healthcare providers
Example: “based on EHR logs/using an experimental study design, we found that healthcare providers who modify at least 3 problems per patient encounter, spend significant less time in their referral letters compared to healthcare providers who do not modify problems at all”
Time period, please tick at least 1 time period
May - November
Contact
Eva Klappe, PhD
Dutch Hospital Data (DHD), Utrecht
e.klappe@dhd.nl
References
Kadlec L. Resolving problem list problems. HIM's role in maintaining an effective EHR problem list. J AHIMA. 2013;84(11):58-9
Klappe E. The solution is the problem list (PhD thesis). 2023.
Klappe E, Joukes E, Cornet R, de Keizer N. Effective and feasible interventions to improve structured EHR data registration and exchange: a concept mapping approach and exploration of practical examples in the Netherlands. International Journal of Medical Informatics. 2023:105023