Electronic medical record modification allows for automated data retrieval

Washington-Urologists at Cleveland Clinic have undertaken a pilot program involving modification of a commercial electronic medical record (EMR) system to facilitate clinical research and clinical practice outcomes analysis in a way that overcomes the obstacles presented by the record-keeping technology.

"EMRs are already common in the U.S. and are about to become mandatory, as will measurements of outcomes," Dr. Shoskes said. "Unfortunately, most commercially available EMRs are designed to justify billing levels, particularly for general practitioners, but they present others with an ongoing struggle trying to use software that was not designed to enable data extraction for outcomes analysis or research purposes. Performing the latter tasks requires having someone go into each patient's EMR, extract the data points of interest, and re-enter the information into a separate database. This is a costly, labor-intensive effort, and the re-entered data are subject to transcription error.

Creating the modification involved collaboration between the physician user and an EMR programmer in order to create new customized forms containing discrete entry fields to capture data of interest. Cleveland Clinic has a full-time person on staff responsible for programming the institution's EMR (Epic, KLAS Enterprises, Verona, WI) who manipulated the system's built-in data warehouse (Clarity) to achieve the automated importation of data from the new forms into the appropriate clinical progress notes and research database.

Forms created for Dr. Shoskes were built to optimize collection of data for his research interest in urologic men's health. Four forms were created that are specific for chronic prostatitis, annual prostate check, BPH surgery, and erectile dysfunction. The forms are accessible by urologists, registered nurses, and physician assistants, and include data fields for laboratory values, symptom scores, clinical history, physical findings, diagnostic classification, and operative data.

Two colleagues within the department of urology are also participating in the pilot program and had forms created with data fields to capture information specific to their areas of interest in oncology and stone disease.

Dr. Shoskes noted that undertaking the modification required approval from Cleveland Clinic's IT department, but that was readily obtained, and the institution's institutional review board was also happy to approve the new registry.

"Members of the IRB were impressed by the added data safety this method confers because it eliminates the need for bringing in outside, nonmedical personnel to identify data through manual review and re-enter it into a new database," he told Urology Times.

Once the modified system is tested in the pilot program, Dr. Shoskes and his colleagues are looking forward to expanding it to create a general registry for all patients that would allow databases to be created both for mandatory outcomes reporting and for any research interest.