Health reform: Is routinely collected electronic information fit for purpose?

Authors

  • Siaw-Teng Liaw,

    Corresponding author
    1. School of Public Health and Community Medicine
    2. Centre for Primary Health Care and Equity, University of New South Wales
    3. General Practice Unit, South West Sydney Local Health District, Sydney, New South Wales, Australia
      Professor Siaw-Teng Liaw, General Practice Unit, Fairfield Hospital, PO Box 5, Fairfield, NSW 1860, Australia. Email: siaw@unsw.edu.au
    Search for more papers by this author
  • Huei-Yang Chen,

    1. Centre for Primary Health Care and Equity, University of New South Wales
    Search for more papers by this author
  • Della Maneze,

    1. Centre for Primary Health Care and Equity, University of New South Wales
    Search for more papers by this author
  • Jane Taggart,

    1. Centre for Primary Health Care and Equity, University of New South Wales
    Search for more papers by this author
  • Sarah Dennis,

    1. School of Public Health and Community Medicine
    2. Centre for Primary Health Care and Equity, University of New South Wales
    Search for more papers by this author
  • Sanjyot Vagholkar,

    1. School of Public Health and Community Medicine
    2. General Practice Unit, South West Sydney Local Health District, Sydney, New South Wales, Australia
    Search for more papers by this author
  • Jeremy Bunker

    1. School of Public Health and Community Medicine
    2. General Practice Unit, South West Sydney Local Health District, Sydney, New South Wales, Australia
    Search for more papers by this author

  • Siaw-Teng Liaw, MB BS, PhD, FRACGP, FACHI, Professor of General Practice; Huei-Yang Chen, MSc, PhD, Research Fellow; Della Maneze, MB BS, Research Associate; Jane Taggart, MPH, Research Fellow; Sarah Dennis, MSc, PhD, Senior Research Fellow; Sanjyot Vagholkar, MB BS, MPH, FRACGP, Staff Specialist; Jeremy Bunker, MB BS, MMEd, FRACGP Staff Specialist.

Professor Siaw-Teng Liaw, General Practice Unit, Fairfield Hospital, PO Box 5, Fairfield, NSW 1860, Australia. Email: siaw@unsw.edu.au

Abstract

Objective: Little has been reported about the completeness and accuracy of data in existing Australian clinical information systems. We examined the accuracy of the diagnoses of some chronic diseases in an ED information system (EDIS), a module of the NSW Health electronic medical record (EMR), and the consistency of the reports generated by the EMR.

Methods: A list of ED attendees and those admitted was generated from the EDIS, using specific (e.g. angina) and possible clinical terms (e.g. chest pain) for the selected chronic diseases. This EDIS list was validated with an audit of discharge summaries, and compared with a list generated, using similar specific and possible Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), from the underlying EMR database.

Results: Of the 33 115 ED attendees, 2559 had diabetes mellitus (DM), cardiovascular disease or asthma/chronic obstructive pulmonary disease; of these 2559, 876 were admitted. Discharge summaries were missing for 12–15% of patients. Only three-quarters or fewer of the diagnoses were confirmed by the discharge summary audit, best for DM and worst for cardiovascular disease. Proportion of agreement between the lists generated from the EDIS and EMR was best for DM and worst for asthma/chronic obstructive pulmonary disease. Possible reasons for this discrepancy are technical, such as use of different extraction terms or system inconsistency; or clinical, such as data entry, decision-making, professional behaviour and organizational performance.

Conclusions: Variations in information quality and consistency of the EDIS/EMR raise concerns about the ‘fitness for purpose’ of the information for care and planning, information sharing, research and quality assurance.

Ancillary