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

Publication ,  Journal Article
Ortel, TL; Arnold, K; Beckman, M; Brown, A; Reyes, N; Saber, I; Schulteis, R; Singh, BP; Sitlinger, A; Thames, EH
Published in: Appl Clin Inform
May 2019

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.

Duke Scholars

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Published In

Appl Clin Inform

DOI

EISSN

1869-0327

Publication Date

May 2019

Volume

10

Issue

3

Start / End Page

552 / 562

Location

Germany

Related Subject Headings

  • Venous Thromboembolism
  • Population Surveillance
  • Humans
  • Hospitals
  • Geography
  • Electronic Health Records
  • Data Mining
  • Autopsy
  • 4203 Health services and systems
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Ortel, T. L., Arnold, K., Beckman, M., Brown, A., Reyes, N., Saber, I., … Thames, E. H. (2019). Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches. Appl Clin Inform, 10(3), 552–562. https://doi.org/10.1055/s-0039-1693711
Ortel, Thomas L., Katie Arnold, Michele Beckman, Audrey Brown, Nimia Reyes, Ibrahim Saber, Ryan Schulteis, Bhavana Pendurthi Singh, Andrea Sitlinger, and Elizabeth H. Thames. “Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches.Appl Clin Inform 10, no. 3 (May 2019): 552–62. https://doi.org/10.1055/s-0039-1693711.
Ortel TL, Arnold K, Beckman M, Brown A, Reyes N, Saber I, et al. Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches. Appl Clin Inform. 2019 May;10(3):552–62.
Ortel, Thomas L., et al. “Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches.Appl Clin Inform, vol. 10, no. 3, May 2019, pp. 552–62. Pubmed, doi:10.1055/s-0039-1693711.
Ortel TL, Arnold K, Beckman M, Brown A, Reyes N, Saber I, Schulteis R, Singh BP, Sitlinger A, Thames EH. Design and Implementation of a Comprehensive Surveillance System for Venous Thromboembolism in a Defined Region Using Electronic and Manual Approaches. Appl Clin Inform. 2019 May;10(3):552–562.
Journal cover image

Published In

Appl Clin Inform

DOI

EISSN

1869-0327

Publication Date

May 2019

Volume

10

Issue

3

Start / End Page

552 / 562

Location

Germany

Related Subject Headings

  • Venous Thromboembolism
  • Population Surveillance
  • Humans
  • Hospitals
  • Geography
  • Electronic Health Records
  • Data Mining
  • Autopsy
  • 4203 Health services and systems
  • 1103 Clinical Sciences