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What evidence is there for a delay in diagnostic coding of rheumatoid arthritis in UK general practice records? An observational study of free text

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journal contribution
posted on 2023-06-13, 14:20 authored by Elizabeth FordElizabeth Ford, John Carroll, Helen Smith, Kevin DaviesKevin Davies, Rob Koeling, Irene Petersen, Greta Rait, Jackie Cassell
Objectives: Much research with electronic health records uses coded or structured data only; important information captured in the free text remains unused. One dimension of EHR data quality assessment is “currency” or timeliness, i.e. that data are representative of the patient state at the time of measurement. We explored the utility of free text in UK general practice patient records to evaluate delays in recording of rheumatoid arthritis (RA) diagnosis. We also aimed to locate and quantify disease and diagnostic information recorded only in text Setting: UK general practice patient records from the Clinical Practice Research Datalink. Participants: 294 individuals with incident diagnosis of RA between 2005 and 2008; 204 women and 85 men, median age 63 years. Primary and Secondary Outcome Measures: Assessment of 1) quantity and timing of text entries for disease modifying anti-rheumatic drugs (DMARDs) as a proxy for the RA disease code, and 2) quantity, location and timing of free text information relating to RA onset and diagnosis. Results: Inflammatory markers, pain and DMARDs were the most common categories of disease information in text prior to RA diagnostic code; 10-37% of patients had such information only in text. Read codes associated with RA-related text included correspondence, general consultation, and arthritis codes. 64 patients (22%) had DMARD text entries >14 days prior to RA code; these patients had more and earlier referrals to rheumatology, tests, swelling, pain, and DMARD prescriptions, suggestive of an earlier implicit diagnosis than was recorded by the diagnostic code. Conclusions: RA-related symptoms, tests, referrals and prescriptions were recorded in free text with 22% of patients showing strong evidence of delay in coding of diagnosis. Researchers using EHRs may need to mitigate for delayed codes by incorporating text into their case-ascertainment strategies. Natural language processing techniques have the capability to do this at scale.

Funding

The ergonomics of electric patient records: an interdisciplinary development of methodologies for understanding and exploiting free text to enhance the utility of primary care electronic patient records; G0011; WELLCOME TRUST; 086105/Z/08/Z

History

Publication status

  • Published

File Version

  • Published version

Journal

BMJ Open

ISSN

2044-6055

Publisher

BMJ Publishing Group

Issue

6

Volume

6

Article number

e010393

Department affiliated with

  • Clinical and Experimental Medicine Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2016-05-06

First Open Access (FOA) Date

2016-05-06

First Compliant Deposit (FCD) Date

2016-05-06

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