Electronic health record problem lists: accurate enough for risk adjustment?

OBJECTIVES

To determine whether comorbidity information derived from electronic health record (EHR) problem lists is accurate.

STUDY DESIGN

Retrospective cohort study of 1596 men diagnosed with prostate cancer between 1998 and 2004 at 2 Southern California Veterans Affairs Medical Centers with long-term follow-up.

METHODS

We compared EHR problem list-based comorbidity assessment with manual review of EHR free-text notes in terms of sensitivity and specificity for identification of major comorbidities and Charlson Comorbidity Index (CCI) scores. We then compared EHR-based CCI scores with free-text-based CCI scores in prediction of long-term mortality.

RESULTS

EHR problem list-based comorbidity assessment had poor sensitivity for detecting major comorbidities: myocardial infarction (8%), cerebrovascular disease (32%), diabetes (46%), chronic obstructive pulmonary disease (42%), peripheral vascular disease (31%), liver disease (1%), and congestive heart failure (23%). Specificity was above 94% for all comorbidities. Free-text-based CCI scores were predictive of long-term other-cause mortality, whereas EHR problem list-based scores were not.

CONCLUSIONS

Inaccuracies in EHR problem list-based comorbidity data can lead to incorrect determinations of case mix. Such data should be validated prior to application to risk adjustment.