CP40 - Accuracy and completeness of cancer history data in community health centers

Poster Type: Research

Primary Funding Source: National Institutes of Health

Category: Technological Solutions and Tools to Improve Care and Population Health Management

Research Objectives: Outpatient Electronic health records (EHRs) may not capture complete or accurate cancer history information. This may be especially true at Community Health Centers (CHCs), which care for underserved cancer survivors. We assessed the accuracy and completeness of cancer history recorded in EHRs of CHCs compared to state cancer registries.

Study Design/Methods: We used retrospective EHR primary care data from the OCHIN community health information network. Data were from 68 health centers and 328 clinic sites serving >1.5 million adult patients in California, Oregon, and Washington. EHR data were linked to the state cancer registries of each state using probabilistic linkage. Cancer records were identified using ICD-O-3 codes for each registry, and ICD-9 and ICD-10-CM codes for EHRs. Measures of agreement (sensitivity, specificity, kappa statistic, and predictive positive value) were computed for ascertainment of any cancer and site-specific agreement using the registry as the gold standard.

Principal Findings and Quantitative/Qualitative Results: Overall, 45% of cancer survivors identified in the registry did not have documentation in the EHR. Similarly, 45% of patient with cancer history noted in EHR did not have a record in the cancer registry. For all states, the overall agreement of having any cancer identified in the EHR compared to the registry was moderate (kappa=0.535). By cancer site, prostate, bladder, and female breast cancers had substantial agreement (kappa >0.60). Cervix and brain/central nervous system cancers had the weakest agreement (kappa <0.30). Cervical cancers were more often identified in EHR than cancer registry data (60% vs. 26%).

Conclusions on Impact on Health Centers: Nearly half of cancer cases recorded in the registries were ‘missing’/not documented in the EHR data. Agreement between EHR and cancer registry data was moderate and varied by cancer site and length of time since diagnosis. These findings stress the important role health technology plays in ascertaining health history, and the need to identify strategies to improve the accuracy and completeness of cancer history in EHRs in CHCs to ensure adequate delivery of care and optimal health outcomes for cancer survivors.

Author(s):

Heather Holderness, Megan Hoopes, Jeffery Soule, Robert Voss, Miguel Marino, Jen DeVoe, Nathalie Huguet