Extending the Contextual and Organizational Elements of Adaptive Structuration Theory in GSS Research

Abstract

OBJECTIVE To determine the validity of an electronic health record (EHR) in the identification of patients with left ventricular dysfunction in a primary care setting. DESIGN A cross-sectional study. SETTING Nine clinics participating from the Providence Research Network (PRN) comprising 75 physicians serving approximately 200,000 patients. All clinics utilise the Logician EHR for all patient care activities. PATIENTS The study included all PRN patients with an active chart. INTERVENTIONS All patients with a heart failure diagnosis in the problem list were identified by database query. Left ventricular ejection fraction (LVEF) data were identified through query of local cardiology and hospital echocardiography databases. Additional LVEF data were sought in a manual search of paper charts. MEASUREMENTS AND MAIN RESULTS To determine the problem list coding accuracy for a heart failure (HF) diagnosis we evaluated sensitivity, positive predictive value and related derived statistical measures using documented LVEF as the 'gold standard'. Of 205 755 active PRN patients, 1731 were identified with a problem list entry of HF. Based on comparison with documented LVEF, the sensitivity for problem list entry was 43.9% and 54.4% when HF was defined as an LVEF < or = 55% and < or = 40%, respectively. CONCLUSION The validity of an EHR problem list entry of HF was poor. The problem list validity could be enhanced through reconciliation with other data sources. Inaccurate EHR problem lists may have clinical consequences, including underprescribing of beneficial therapies.