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Science-Technology

Published on January 12, 2009

Author: aSGuest10171

Source: authorstream.com

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Underdiagnosis of Pediatric Hypertension – An Example of the Potential of Electronic Medical Record Research for Clinical Pediatricians : Underdiagnosis of Pediatric Hypertension – An Example of the Potential of Electronic Medical Record Research for Clinical Pediatricians David C Kaelber, MD, PhD Internal Medicine and Pediatrics Physician National Library of Medicine Medical Informatics Fellow Center for Information Technology Leadership (CITL) Staff Physician Children's Hospital Boston, Brigham and Women’s Hospital, Massachusetts General Hospital, and Massachusetts General Hospital for Children Disclosures : Disclosures I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. Background : Background Background : Background Need 3 measurements for diagnosis of hypertension (HTN) or prehypertension (preHTN). 2-5% of all children have hypertension. Study Design : Study Design Design: Cohort study. Setting: Outpatient clinics in a large, academic, urban medical system in Northeast Ohio. Patients: 14187 children and adolescents age 3-18 years who were seen at least three times for well-child care between June 1999 and September 2006. Main Outcome Measures: Diagnosis of hypertension or prehypertension documented in the electronic medical record (EMR). Logistic regression analysis was performed to identify factors associated with a correct diagnosis. EMR Data Collection : EMR Data Collection Basic Information MR# birth date gender race primary care physician past medical history past surgical history family history Visit information visit date visit site BP reading(s) height reading weight reading diagnosis code(s) (ICD9) problem list code(s) (ICD9) order(s) billing code(s) Study Results : Study Results Study Results : Study Results Study Results – HTN factors : Study Results – HTN factors Slide 10: Distribution of Task and # of hours to complete tasks. 1 – actual time for this EMR study 2 – estimated time for equivalent paper chart study (assumes 1 minute for initial screen and 5 minutes to find and extract data) Study Timeline : Study Timeline April June August October December August 2007 2007 2007 2007 2007 2008 Clinical Observation Study Design and Team IRB Approved Data Obtained and Analyzed PAS Abstract Submitted 1 3rd year medical school student, 1 4th year medical school student, 1 medical informatics fellow, ~150 hours, ~17 months, $0 ML Hanson, PW Gunn, and DC Kaelber. Underdiagnosis of Hypertension in Children and Adolescents. Journal of the American Medical Association. 298(8):874-9. 2007. Clinical Research Implications(retrospective clinical research) : Clinical Research Implications(retrospective clinical research) Order of magnitude less time and money with electronic medical records. Conclusions : Conclusions Electronic medical records have the potential to create a paradigm shift in retrospective clinical research. This paradigm shift can make clinical research much for accessible for clinical pediatricians. Slide 14: Questions?? Comments?? dkaelber@partners.org or david.kaelber@case.edu

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