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Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain

Patients’ medical histories are the salient dataset for diagnosis. Prior work shows consistently, however, that medical history-taking by physicians generally is incomplete and not accurate. Such findings suggest that methods to improve the completeness and accuracy of medical history data could hav...

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Autores principales: Zakim, David, Brandberg, Helge, El Amrani, Sami, Hultgren, Andreas, Stathakarou, Natalia, Nifakos, Sokratis, Kahan, Thomas, Spaak, Jonas, Koch, Sabine, Sundberg, Carl Johan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476015/
https://www.ncbi.nlm.nih.gov/pubmed/34570811
http://dx.doi.org/10.1371/journal.pone.0257677
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author Zakim, David
Brandberg, Helge
El Amrani, Sami
Hultgren, Andreas
Stathakarou, Natalia
Nifakos, Sokratis
Kahan, Thomas
Spaak, Jonas
Koch, Sabine
Sundberg, Carl Johan
author_facet Zakim, David
Brandberg, Helge
El Amrani, Sami
Hultgren, Andreas
Stathakarou, Natalia
Nifakos, Sokratis
Kahan, Thomas
Spaak, Jonas
Koch, Sabine
Sundberg, Carl Johan
author_sort Zakim, David
collection PubMed
description Patients’ medical histories are the salient dataset for diagnosis. Prior work shows consistently, however, that medical history-taking by physicians generally is incomplete and not accurate. Such findings suggest that methods to improve the completeness and accuracy of medical history data could have clinical value. We address this issue with expert system software to enable automated history-taking by computers interacting directly with patients, i.e. computerized history-taking (CHT). Here we compare the completeness and accuracy of medical history data collected and recorded by physicians in electronic health records (EHR) with data collected by CHT for patients presenting to an emergency room with acute chest pain. Physician history-taking and CHT occurred at the same ED visit for all patients. CHT almost always preceded examination by a physician. Data fields analyzed were relevant to the differential diagnosis of chest pain and comprised information obtainable only by interviewing patients. Measures of data quality were completeness and consistency of negative and positive findings in EHR as compared with CHT datasets. Data significant for the differential of chest pain was missing randomly in all EHRs across all data items analyzed so that the dimensionality of EHR data was limited. CHT files were near complete for all data elements reviewed. Separate from the incompleteness of EHR data, there were frequent factual inconsistencies between EHR and CHT data across all data elements. EHR data did not contain representations of symptoms that were consistent with those reported by patients during CHT. Trial registration: This study is registered at https://www.clinicaltrials.gov (unique identifier: NCT03439449).
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spelling pubmed-84760152021-09-28 Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain Zakim, David Brandberg, Helge El Amrani, Sami Hultgren, Andreas Stathakarou, Natalia Nifakos, Sokratis Kahan, Thomas Spaak, Jonas Koch, Sabine Sundberg, Carl Johan PLoS One Research Article Patients’ medical histories are the salient dataset for diagnosis. Prior work shows consistently, however, that medical history-taking by physicians generally is incomplete and not accurate. Such findings suggest that methods to improve the completeness and accuracy of medical history data could have clinical value. We address this issue with expert system software to enable automated history-taking by computers interacting directly with patients, i.e. computerized history-taking (CHT). Here we compare the completeness and accuracy of medical history data collected and recorded by physicians in electronic health records (EHR) with data collected by CHT for patients presenting to an emergency room with acute chest pain. Physician history-taking and CHT occurred at the same ED visit for all patients. CHT almost always preceded examination by a physician. Data fields analyzed were relevant to the differential diagnosis of chest pain and comprised information obtainable only by interviewing patients. Measures of data quality were completeness and consistency of negative and positive findings in EHR as compared with CHT datasets. Data significant for the differential of chest pain was missing randomly in all EHRs across all data items analyzed so that the dimensionality of EHR data was limited. CHT files were near complete for all data elements reviewed. Separate from the incompleteness of EHR data, there were frequent factual inconsistencies between EHR and CHT data across all data elements. EHR data did not contain representations of symptoms that were consistent with those reported by patients during CHT. Trial registration: This study is registered at https://www.clinicaltrials.gov (unique identifier: NCT03439449). Public Library of Science 2021-09-27 /pmc/articles/PMC8476015/ /pubmed/34570811 http://dx.doi.org/10.1371/journal.pone.0257677 Text en © 2021 Zakim et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Zakim, David
Brandberg, Helge
El Amrani, Sami
Hultgren, Andreas
Stathakarou, Natalia
Nifakos, Sokratis
Kahan, Thomas
Spaak, Jonas
Koch, Sabine
Sundberg, Carl Johan
Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain
title Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain
title_full Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain
title_fullStr Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain
title_full_unstemmed Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain
title_short Computerized history-taking improves data quality for clinical decision-making—Comparison of EHR and computer-acquired history data in patients with chest pain
title_sort computerized history-taking improves data quality for clinical decision-making—comparison of ehr and computer-acquired history data in patients with chest pain
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476015/
https://www.ncbi.nlm.nih.gov/pubmed/34570811
http://dx.doi.org/10.1371/journal.pone.0257677
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