An EPIC Hierarchical Data Collection Schema to Assess Contraceptive Counseling in Primary Care [24A]. (May 2017)

• Record Type: Journal Article
• Authors: Roser, Brittany; Rubin, Susan; Nagarajan, Nisha; Benfield, Nerys
• Is Part Of: Obstetrics and gynecology. Volume 129 (2017)Supplement 1
• Publication Date: 2017-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000514258.57261.fc
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: In 2011 the Institute of Medicine designated contraceptive counseling and provision an essential service. Electronic medical record (EMR) systems provide large volumes of clinical data but the quality of this data varies, especially when no billing, lab or prescription is given. As part of a quality improvement initiative, we sought to develop a reliable algorithm using EPIC EMR to measure rates of contraception counseling at outpatient primary care sites. METHODS: We constructed an initial hierarchical data collection schema using prescription data, ICD and CPT codes, and text searching, in this order. We refined the schema through an iterative validation process including three cycles of manual chart review. We applied the schema to eight outpatient urban family medicine, general obstetrics and gynecology, and family planning sites affiliated with one academic medical center. RESULTS: From August 2015 to May 2016, the eight sites averaged 2500 unique monthly visits by women aged 14-45. Among visits where contraception counseling and/or provision was documented, 18.6% were captured by prescriptions, 8.9% by ICD and CPT codes, and 69.7% by text search. Among visits where contraceptive counseling was documented but no method was provided, 15.7% were captured by diagnosis codes and 84.3% by text search. CONCLUSION: This hierarchical data collection schema allowed us to obtain robust measures of contraception counseling and provision in primary care practices. Inclusion of text search in addition to prescription and ICD/CPT coding is crucial for data accuracy and comprehensiveness. This schema could be adapted by other EPIC EMR users interested in real-time quality assessment.