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The Reliability of Computerized Physician Order Entry Data for Research Studies

Dexheimer, Judith W., PhD*†‡; Taylor, Regina G., MS*; Kachelmeyer, Andrea M., BS*; Reed, Jennifer L., MD, MS*‡

Section Editor(s): Harper, Marvin B. MD; Associate Editor; Hoffman, Jeffrey M. MD; Associate Editor; Zorc, Joseph J. MD, MSCE; Associate Editor

doi: 10.1097/PEC.0000000000001726
IT in the ED

Objectives In the United States, adolescents account for nearly half of the newly diagnosed sexually transmitted infections annually, and many of these infections are asymptomatic. Adolescents often seek care in pediatric emergency departments; thus, the emergency department is an important setting to implement adolescent sexually transmitted infection screening. Before implementation, baseline data reflecting current screening rates of symptomatic and asymptomatic patients were needed. This study aimed to evaluate the accuracy of provider-reported rates of symptomatic and asymptomatic chlamydia (CT) and gonorrhea (GC) testing in adolescents overall and pre–electronic health record (EHR) and post-EHR order modification in preparation for a research intervention.

Methods This was a 1-year prospective, observational study. Provider reason for CT/GC testing was added to the existing EHR order. Chart reviews were performed to ensure the accuracy of clinician CT/GC testing choices (symptomatic vs asymptomatic). Frequencies of testing choices were obtained. Order modifications were made to further clarify the definitions. A Student t test was used to compare data preorder and postorder modification.

Results When relying on providers to report reasons for CT/GC testing (symptomatic vs asymptomatic), many patients were misclassified based on a priori defined testing reasons. After order modification, rates of provider-reported symptomatic testing remained unchanged (P = 0.16). Provider-reported asymptomatic testing significantly declined (P = 0.004); however, 23.2% of those tested continued to be misclassified.

Conclusions Provider-entered EHR data are increasingly being used in research studies; thus, it is important to ensure its accuracy and reliability before study implementation.

From the *Division of Emergency Medicine and

Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center; and

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

Disclosure: The authors declare no conflict of interest.

Reprints: Jennifer L. Reed, MD, MS, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, MLC 2008, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (e-mail:

Funding: Supported by National Institutes of Health Award Number K23HD075751 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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