Joshua R Lakin1,2,3, Daniel A Gundersen4, Charlotta Lindvall1,2,3, Michael K Paasche-Orlow5, James A Tulsky1,2,3, Elise N Brannen6, Kathryn I Pollak7,8, Danielle Kennedy8, Jody-Ann McLeggon9, Jeremiah J Stout10, Angelo Volandes3,11. 1. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 2. Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 3. Harvard Medical School, Boston, Massachusetts, USA. 4. Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 5. Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. 6. School of Medicine, Oregon Health and Science University, Portland, Oregon, USA. 7. Department of Population Health Sciences, Duke University, Durham, North Carolina, USA. 8. Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina, USA. 9. Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA. 10. Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA. 11. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% -48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.
Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% -48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.
Entities:
Keywords:
advance care planning; electronic health records; end-of-life care; patient-physician communication
Authors: Angelo E Volandes; Sophia N Zupanc; Michael K Paasche-Orlow; Joshua R Lakin; Yuchiao Chang; Edith A Burns; Nancy A LaVine; Maria T Carney; Diana Martins-Welch; Kaitlin Emmert; Jennifer E Itty; Edward T Moseley; Aretha D Davis; Areej El-Jawahri; Daniel A Gundersen; Gemmae M Fix; Andrea M Yacoub; Pamela Schwartz; Shira Gabry-Kalikow; Cynthia Garde; Jonathan Fischer; Lori Henault; Leah Burgess; Julie Goldman; Anne Kwok; Nimisha Singh; Armando L Alvarez Suarez; Valeria Gromova; Sonia Jacome; James A Tulsky; Charlotta Lindvall Journal: JAMA Netw Open Date: 2022-02-01
Authors: Rachel L Richesson; Keith S Marsolo; Brian J Douthit; Karen Staman; P Michael Ho; Dana Dailey; Andrew D Boyd; Kathleen M McTigue; Miriam O Ezenwa; Judith M Schlaeger; Crystal L Patil; Keturah R Faurot; Leah Tuzzio; Eric B Larson; Emily C O'Brien; Christina K Zigler; Joshua R Lakin; Alice R Pressman; Jordan M Braciszewski; Corita Grudzen; Guilherme Del Fiol Journal: J Am Med Inform Assoc Date: 2021-11-25 Impact factor: 4.497
Authors: Nwamaka D Eneanya; Joshua R Lakin; Michael K Paasche-Orlow; Charlotta Lindvall; Edward T Moseley; Lori Henault; Amresh D Hanchate; Ernest I Mandel; Susan P Y Wong; Sophia N Zupanc; Aretha Delight Davis; Areej El-Jawahri; Lisa M Quintiliani; Yuchiao Chang; Sushrut S Waikar; Amar D Bansal; Jane O Schell; Andrew L Lundquist; Manjula Kurella Tamura; Margaret K Yu; Mark L Unruh; Christos Argyropoulos; Michael J Germain; Angelo Volandes Journal: BMJ Open Date: 2022-04-08 Impact factor: 2.692