Electronic Medical Record Inaccuracies: Multicenter Analysis of Challenges with Modified Lung Cancer Screening...

Area of Science:

• Pulmonology
• Oncology
• Health Informatics

Background:

• National Comprehensive Cancer Network expanded lung cancer screening (LCS) criteria to include chronic obstructive pulmonary disease (COPD) as a clinical risk factor.
• Electronic medical records (EMR) can identify high-risk populations for LCS, but unsubstantiated COPD diagnoses may lead to inappropriate referrals.

Purpose of the Study:

• To determine the prevalence of unsubstantiated COPD diagnoses in EMRs for LCS referrals.
• To assess the efficacy of EMRs as an accurate population-based screening tool using modified clinical criteria.

Main Methods:

• Multicenter review of individuals referred to LCS programs (2012-2015).
• EMR search for COPD diagnostic terms and pulmonary function tests (PFTs).
• Unsubstantiated COPD defined by COPD term without PFTs or PFTs without obstruction evidence.

Main Results:

• 30% (840/2834) of referred individuals had a COPD term in their EMR.
• 68% (571/840) of these COPD diagnoses were unsubstantiated.
• Absent PFTs accounted for 86% of unsubstantiated diagnoses; PFTs without obstruction accounted for 14%.

Conclusions:

• A significant proportion of individuals referred for LCS have unsubstantiated COPD diagnoses in their EMR.
• Using EMRs with expanded criteria for population-based screening may result in inappropriate LCS referrals.