Appl Clin Inform 2019; 10(03): 552-562
DOI: 10.1055/s-0039-1693711
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches

Thomas L. Ortel
1  Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States
2  Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States
,
Katie Arnold
3  Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
,
Michele Beckman
4  Centers for Disease Control and Prevention, Atlanta, Georgia, United States
,
Audrey Brown
5  Social & Scientific Systems, Inc., Durham, North Carolina, United States
,
Nimia Reyes
4  Centers for Disease Control and Prevention, Atlanta, Georgia, United States
,
Ibrahim Saber
1  Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States
,
Ryan Schulteis
6  Durham Veterans' Administration Medical Center, Durham, North Carolina, United States
,
Bhavana Pendurthi Singh
7  MedStar Georgetown University Hospital, Washington, District of Columbia, United States
,
Andrea Sitlinger
8  Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States
,
Elizabeth H. Thames
1  Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States
› Author Affiliations
Further Information

Publication History

27 March 2019

16 June 2019

Publication Date:
31 July 2019 (online)

Abstract

Background Systematic surveillance for venous thromboembolism (VTE) in the United States has been recommended by several organizations. Despite adoption of electronic medical records (EMRs) by most health care providers and facilities, however, systematic surveillance for VTE is not available.

Objectives This article develops a comprehensive, population-based surveillance strategy for VTE in a defined geographical region.

Methods The primary surveillance strategy combined computerized searches of the EMR with a manual review of imaging data at the Duke University Health System in Durham County, North Carolina, United States. Different strategies of searching the EMR were explored. Consolidation of results with autopsy reports (nonsearchable in the EMR) and with results from the Durham Veterans' Administration Medical Center was performed to provide a comprehensive report of new VTE from the defined region over a 2-year timeframe.

Results Monthly searches of the primary EMR missed a significant number of patients with new VTE who were identified by a separate manual search of radiology records, apparently related to delays in data entry and coding into the EMR. Comprehensive searches incorporating a location-restricted strategy were incomplete due to the assigned residence reflecting the current address and not the address at the time of event. The most comprehensive strategy omitted the geographic restriction step and identified all patients with VTE followed by manual review of individual records to remove incorrect entries (e.g., outside the surveillance time period or geographic location; no evidence for VTE). Consolidation of results from the EMR searches with results from autopsy reports and the separate facility identified additional patients not diagnosed within the Duke system.

Conclusion We identified several challenges with implementing a comprehensive VTE surveillance program that could limit accuracy of the results. Improved electronic strategies are needed to cross-reference patients across multiple health systems and to minimize the need for manual review and confirmation of results.

Protection of Human and Animal Subjects

This population-based surveillance study was deemed exempt from review by the Duke IRB since it met all of the specified criteria covered in 45 CFR 46.101 (b) 5.


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