BMJ 2001;322:1401-1405 ( 9 June )

Information in practice

A survey of validity and utility of electronic patient records in a general practice

Alan Hassey, general practitioner, a David Gerrett, senior research fellow, b Ali Wilson, senior associate lecturer. c

a Fisher Medical Centre, Millfields, Skipton BD23 1EU, b School of Health and Community Studies, University of Derby, Kingsway, Derby DE22 3HL, c Research School of Medicine, University of Leeds, Leeds LS2 9LN

Correspondence to: A Hassey alan.hassey{at}btinternet.com

Objective: To develop methods of measuring the validity and utility of electronic patient records in general practice.
Design: A survey of the main functional areas of a practice and use of independent criteria to measure the validity of the practice database.
Setting: A fully computerised general practice in Skipton, north Yorkshire.
Subjects: The records of all registered practice patients.
Main outcome measures: Validity of the main functional areas of the practice clinical system. Measures of the completeness, accuracy, validity, and utility of the morbidity data for 15 clinical diagnoses using recognised diagnostic standards to confirm diagnoses and identify further cases. Development of a method and statistical toolkit to validate clinical databases in general practice.
Results: The practice electronic patient records were valid, complete, and accurate for prescribed items (99.7%), consultations (98.1%), laboratory tests (100%), hospital episodes (100%), and childhood immunisations (97%). The morbidity data for 15 clinical diagnoses were complete (mean sensitivity=87%) and accurate (mean positive predictive value=96%). The presence of the Read codes for the 15 diagnoses was strongly indicative of the true presence of those conditions (mean likelihood ratio=3917). New interpretations of descriptive statistics are described that can be used to estimate both the number of true cases that are unrecorded and quantify the benefits of validating a clinical database for coded entries.
Conclusion: This study has developed a method and toolkit for measuring the validity and utility of general practice electronic patient records.


What is already known on this topic
Delivering the performance management agenda in the NHS will depend on the availability of high quality information in general practice

Record entries in GP systems generally consist of a mixture of text and Read coded entries

Sensitivity and positive predictive value have been used to measure the completeness and accuracy of data recording in electronic patient record systems

What this study adds
This study has developed a standard method and toolkit for measuring the validity and utility of electronic patient record systems

The principal innovation in this study is to consider the Read codes in the records as tests for the true presence of the associated diagnoses

This study has developed a new approach to the validation of electronic patient record systems.



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Rapid Responses:

Read all Rapid Responses

Textbooks are sometimes wrong
G H Hall
bmj.com, 11 Jun 2001 [Full text]
Re: Textbooks are sometimes wrong
Alan Hassey
bmj.com, 12 Jun 2001 [Full text]
Validity of electronic patient records
Bernard Fernando
bmj.com, 21 Jun 2001 [Full text]
Published methods of measuring the accuracy of electronic records do exist
Philip J Bayliss Brown
bmj.com, 2 Jul 2001 [Full text]
Dangers in methods of evaluation of electronic patient records
Robert G Newcombe
bmj.com, 4 Jul 2001 [Full text]
Re: Dangers in methods of evaluation of electronic patient records
Alan Hassey
bmj.com, 6 Jul 2001 [Full text]
Re: Published methods of measuring the accuracy of electronic records do exist
Alan Hassey, et al.
bmj.com, 10 Jul 2001 [Full text]
Re: Dangers in methods of evaluation of electronic patient records
lan Hassey
bmj.com, 19 Jul 2001 [Full text]
Re: Re: Dangers in methods of evaluation of electronic patient records
Alan Hassey
bmj.com, 5 Aug 2001 [Full text]
Trying it out.
Phil Hughes
bmj.com, 3 Oct 2001 [Full text]
Re: Trying it out.
Alan Hassey
bmj.com, 8 Oct 2001 [Full text]
Guidance for GPs
susanne McCabe
bmj.com, 2 Oct 2003 [Full text]
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