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Feasibility of Integrating Research Data Collection Into Routine Clinical Practice Using the Epic Electronic Medical Record

Sunday, October 21, 2012: 2:36 PM
Grand Ballroom B (Hilton Riverside)
Vijaya M. Vemulakonda, M.D., J.D., Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, Duncan T. Wilcox, M.D., Pediatric Urology, Children's Hospital Colorado, Aurora, CO and Michael G. Kahn, Clinical Informatics, Children's Hospital Colorado, Aurora, CO

Purpose: With the widespread use of electronic medical records (EMR) in the United States, studies have suggested the potential use of the EMR as a data collection tool for pediatric clinical research. The primary objective of this study is to evaluate the feasibility and completeness of data collection using research data fields integrated into the clinical note in the Epic EMR.

Methods: After institutional review board approval was obtained, we incorporated data fields in the history and physical exam portions of the clinical notes template for patients seen by the Department of Pediatric Urology at Children’s Hospital Colorado. Compliance with templates was not measured; however use of the templates is standard practice in our department. We then retrospectively reviewed use of these data fields from 11/1/2011 to 4/15/2012. Data were extracted from the EMR using standard automated electronic data extraction techniques. Data fields assessed included location of clinic visit, primary complaint, and genital exam.  Fields included in the history were limited to a series of discrete options; fields included in the physical exam portion of the note included both discrete options as well as a wild card free text option. Data extracted from the integrated research fields were then assessed for overall use, as well as differences in use based on location of the research field and availability of designated options and wild card free text. Data were evaluated using the Student’s t-test. 

Results:  A total of 1375 notes for 1270 discrete patients were examined. Of data fields included in the history portion of the template note, 82.7 were filled out using a discrete choice option. The data field was deleted in 17.3% of cases. Of data fields included in the physical exam portion of the template note, 75.1% were filled out and 24.9% were deleted. Of fields filled out in the physical exam, 32.3% utilized the wild card free text option. The difference in use of history fields compared to use of physical exam fields was statistically significant (t=4.88; p<0.001).

Conclusion: This study is the first to demonstrate the feasibility of integrating research data collection into routine pediatric urologic clinical practice by incorporating data fields into the clinical notes template in the Epic EMR system. This study also suggests that physicians are more likely to use research data fields with discrete choice options in the history portion of the note than in the physical exam portion of the note. Further studies are needed to determine if this method of data collection is feasible to establish a research network across multiple sites with multiple EMR configurations.