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Can decision support combat incompleteness and bias in routine primary care data?
Olga Kostopoulou1, Christopher Tracey1, Brendan C Delaney1
1Department of Surgery and Cancer, Imperial College London, St Mary's Campus, Norfolk Place, London, UK.
Summary
A decision support system (DSS) improved electronic health record (EHR) data completeness by increasing coded entries and reducing free text. This enhances the quality of routine primary care data for research.
Area of Science:
- Health Informatics
- Clinical Decision Support
- Primary Care Research
Background:
- Routine primary care data are crucial for clinical prediction rules and risk scores.
- Electronic health records (EHRs) in primary care may suffer from incomplete data and cognitive biases.
- The impact of decision support systems (DSS) on the completeness and accuracy of EHR data is not fully understood.
Purpose of the Study:
- To evaluate the effect of a DSS on the completeness and bias of primary care data.
- To assess how a DSS influences the proportion of diagnosis-related data documented in EHRs.
Main Methods:
- Utilized clinical documentation from 34 UK general practitioners and 12 standardized patients.
- Compared EHR documentation from baseline consultations (EHR only) with supported consultations (EHR-integrated DSS).
- Measured the proportion of EHR data items related to the physician's final diagnosis, including codes and free text.
Main Results:
- Supported consultations showed significantly more coded entries (IRR = 5.76) and less free text (IRR = 0.32) compared to baseline.
- The proportion of diagnosis-related data was significantly lower in supported consultations for both codes and free text (b = -0.08).
- The DSS facilitated data coding, leading to more comprehensive documentation.
Conclusions:
- Physician data entry in EHRs is often incomplete and influenced by cognitive biases, impacting epidemiological research.
- A DSS that aids and encourages data entry during consultations can significantly improve the quality of routine documentation.
- Enhanced data completeness from DSS use has positive implications for the reliability of primary care data in research.
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