Computer-facilitated Review of Electronic Medical Records Reliably Identifies Emergency Department Interventions in Older Adults

Objectives An estimated 14% to 25% of all scientific studies in peer-reviewed emergency medicine (EM) journals are medical records reviews. The majority of the chart reviews in these studies are performed manually, a process that is both time-consuming and error-prone. Computer-based text search engines have the potential to enhance chart reviews of electronic emergency department (ED) medical records. The authors compared the efficiency and accuracy of a computer-facilitated medical record review of ED clinical records of geriatric patients with a traditional manual review of the same data and describe the process by which this computer-facilitated review was completed. Methods Clinical data from consecutive ED patients age 65years or older were collected retrospectively by manual and computer-facilitated medical record review. The frequency of three significant ED interventions in older adults was determined using each method. Performance characteristics of each search method, including sensitivity and positive predictive value, were determined, and the overall sensitivities of the two search methods were compared using McNemar's test. Results For 665 patient visits, there were 49 (7.4%) Foley catheters placed, 36 (5.4%) sedative medications administered, and 15 (2.3%) patients who received positive pressure ventilation.The computer-facilitated review identified more of the targeted procedures (99 of 100, 99%), compared to manual review (74 of 100 procedures, 74%; p<0.0001). Conclusions A practical, non-resource-intensive, computer-facilitated free-text medical record review was completed and was more efficient and accurate than manually reviewing ED records. Resumen La Revision Computarizada de las Historias Clinicas Electronicas Identifica de Manera Fiable las Intervenciones del Servicio de Urgencias en los Ancianos Objetivos Se estima que el 14-25% de todos los estudios cientificos en revistas biomedicas de medicina de urgencias y emergencias son revisiones de historias clinicas. La mayoria de las revisiones de las historias en estos estudios se realiza de forma manual, un proceso que consume tiempo y conlleva errores. Los motores de busqueda de texto computarizados tienen el potencial de mejorar las revisiones de las historias medicas electronicas del servicio de urgencias (SU). Se comparo la eficiencia y la fiabilidad de una revision computarizada de las historias clinicas del SU de los pacientes geriatricos frente a una revision manual tradicional de los mismos datos, y se describio el proceso mediante el cual se completo esta revision computarizada. Metodologia Se recogieron de forma retrospectiva los datos clinicos de pacientes consecutivos de 65 anos o mas atendidos en el SU mediante la revision de la historia medica manual y computarizada. Se determino, usando cada metodo, la frecuencia de tres intervenciones significativas en el SU en los ancianos. Se determinaron las caracteristicas de realizacion de cada metodo de busqueda, incluyendo la sensibilidad y el valor predictivo positivo, y se comparo la sensibilidad global de los dos metodos de busqueda mediante el test de McNemar. Resultados Para 665 visitas de pacientes, hubo 49 (7,4%) sondajes, 36 (5,4%) medicaciones sedantes administradas y 15 (2,3%) pacientes que recibieron ventilacion con presion positiva. La revision computarizada identifico mas procedimientos objetivos, 99 de 100 (99%), comparado con la revision manual (74 de 100 procedimientos; 74%) (p<0,0001). Conclusiones La revision de la historia clinica de texto libre facilitada electronicamente se realizo de forma practica y sin grandes recursos, y fue mas eficiente y certera que la revision manual de las historias del SU.