Subscribe or Manage Preferences
Rheumatology Practice Management February 2015 Vol 3 No 1 - Health Information Technology, Online Exclusives
Rosemary Frei, MSc

Electronic medical records represent unfulfilled promise for identifying patients who are at elevated risk for osteoporosis and fragility fractures, according to a survey of the situation in Ontario, Canada. As reported at the American Medical Informatics Association 2014 Annual Symposium, electronic medical records (EMRs) from family physicians across the province of Ontario that were contributed to a database dubbed EMRALD (EMR Administrative Data Linked Database) contain widely varying report formats for bone mineral density (BMD) results.1 EMRALD was created in 2007 by Karen Tu, MD, and her colleagues from the Department of Family and Community Medicine, University of Toronto. It is housed at the Institute for Clinical Evaluative Sciences in Toronto.

“It’s encouraging that there are a lot of BMD exam results in EMRALD, but a bit discouraging to see how variably the results and other information about osteoporosis are stored,” presenter Sonya Allin, PhD, told Value-Based Care in Rheumatology. For example, among the osteoporosis patients included in the electronic-record review “only about half had BMD exam results in the EMRs and less than two-thirds had their osteoporosis diagnosis coded in their patient profile.” Some members of the same research team showed in an earlier study that there is a woefully low rate of age-standardized BMD testing within 6 months of a fracture in Ontario patients.2

Allin, a researcher in the Department of Physical Therapy, University of Toronto, and Tu, and their coinvestigators focused on 15,365 patients in EMRALD who had diagnostic-imaging entries for BMD exams. They found that, while the rate of BMD testing recorded in EMRALD does reflect the rate shown in records from the provincial health agency, pulling diagnoses and fracture risk information from EMRALD’s BMD reports was complicated by lack of standardization. Among all the patients with BMD exam entries in EMRALD, 27.8% did not have BMD results in searchable text format, and 8% did not mention the term T-score. Even when text entries did contain a BMD exam result, the formats were “extremely varied,” noted the researchers: 27.3% were less than 200 characters long and many were short annotations from primary care physicians. Most of the BMD results were attached to the EMR either as an image or scan.

Furthermore, when members of the research team manually reviewed the EMRs of some of the patients, they found only 55.8% of osteoporosis patients’ BMD results were readily accessible. The most common place for a mention of the osteoporosis diagnoses in the EMRs, at 90.2%, was in a note from a primary care provider attached to an individual patient exam.

Fortunately, the patients in EMRALD who experienced a fragility fracture did seem to be relatively well investigated for osteoporosis.

“In the future, we’d like to relate the representation of fragility fractures in the EMR to their representation in administrative data sources; this might tell us how many fractures are not communicated to primary care providers by patients,” reflected Allin. She also noted that comparable data quality issues are likely present in American primary care physicians’ EMRs and administrative databases.

References

  1. Allin S, Munce S, Jaglal S, et al. Capture of osteoporosis and fracture information in an electronic medical record database from primary care. Presented at: American Medical Informatics Association 2014 Annual Symposium; November 15-19, 2014; Washington, DC. http://knowledge.amia.org/. Accessed January 5, 2015.
  2. Jaglal S, Hawker G, Croxford R, et al. Impact of a change in physician reimbursement on bone mineral density testing in Ontario, Canada: a population-based study. CMAJ Open. 2014;2(2):E45-E50. www.cmajopen.ca/content/2/2/E45.full. Accessed January 5, 2015.
Related Items
Medications Used for the Treatment of Prostate Cancer and the Associated ICD-10 Codes
Kristin A. Esposito, CPhT
Urology Practice Management - Web Exclusives published on November 15, 2017 in ICD Codes, Online Exclusives
Tadalafil Significantly Reduces Symptoms of Erectile Dysfunction and LUTS/BPH
Rosemary Frei, MSc
Urology Practice Management - April 2016, Vol 5, No 2 published on May 4, 2016 in Erectile Dysfunction
ACR Responds to Continued Expansion of Physician Compare
Rosemary Frei, MSc
Rheumatology Practice Management February 2016 Vol 4 No 1 published on March 10, 2016 in Medicare
Boosting Blueberry Intake May Keep Erectile Dysfunction Risk at Bay
Rosemary Frei, MSc
Urology Practice Management - February 2016, Vol 5, No 1 published on February 19, 2016 in Erectile Dysfunction
CMS Reimbursement Policies Resulted in Overuse of Office-Based Cystoscopic Procedures
Rosemary Frei, MSc
Urology Practice Management - February 2016, Vol 5, No 1 published on February 19, 2016 in Reimbursement
CMS Unveils Equity Plan to Improve Quality, Increase Access to Care
Rosemary Frei, MSc
Urology Practice Management - December 2015, Vol 4, No 6 published on December 28, 2015 in Health Policy
Bladder Cancer Tumor Staging Postchemotherapy Accurately Predicts Survival
Rosemary Frei, MSc
Urology Practice Management - December 2015, Vol 4, No 6 published on December 28, 2015 in Bladder Cancer
New Mobile App Lets Men with LUTS Go with the Flow
Rosemary Frei, MSc
Urology Practice Management - December 2015, Vol 4, No 6 published on December 28, 2015 in Urinary Tract Symptoms
Medicare Will Begin Reimbursing for Advance Care Planning Discussions in 2016
Rosemary Frei, MSc
Oncology Practice Management - December 2015, Vol 5, No 9 published on December 22, 2015 in Reimbursement
CMS Unveils Equity Plan to Improve Access to Care, Patient Outcomes
Rosemary Frei, MSc
Oncology Practice Management - November 2015, Vol 5, No 8 published on November 11, 2015 in Health Policy
Last modified: August 6, 2015
  • American Health and Drug Benefits
  • Lynx CME
  • Value Based Care in Rheumatology
  • Oncology Practice Management
  • Urology Practice Management

Search