Accurate case finding using linked electronic clinical and administrative data at a children's hospital

To link hospital administrative data and an electronic medical record at a children's hospital in order to identify children with cancer admitted for fever and neutropenia. Hospital administrative data concerning 13,374 inpatient and outpatient encounters were validated against and linked to clinical data stored in an electronic medical record. Queries of the linked databases identified children with fever and neutropenia. Sensitivity and specificity of the experimental case-finding strategy were determined and compared to a control case-finding strategy utilizing administrative data alone. Linking of the clinical record to the administrative record was achieved in 233 (99%) of the 235 records. Of 1680 data elements reviewed from the administrative data that were also potentially available in the clinical data system, 1679 (99.9%) were verified in the electronic medical record. The experimental strategy for case finding had a sensitivity of 73.1% (95% CI: 58.1, 88.3), specificity 99.6% (95% CI: 99.1, 100). If only administrative data such as diagnosis-related group and hospital service were used for case finding, both the sensitivity (P < 0.01) and specificity (P < 0.01) were significantly lower. Linking a children's hospital administrative data system with clinical data is feasible and can be utilized for specific case finding for a common and costly condition in children.