Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States.
Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States.
Appl Clin Inform. 2019 May;10(3):552-562. doi: 10.1055/s-0039-1693711. Epub 2019 Jul 31.
Systematic surveillance for venous thromboembolism (VTE) in the United States has been recommended by several organizations. Despite adoption of electronic medical records (EMRs) by most health care providers and facilities, however, systematic surveillance for VTE is not available.
This article develops a comprehensive, population-based surveillance strategy for VTE in a defined geographical region.
The primary surveillance strategy combined computerized searches of the EMR with a manual review of imaging data at the Duke University Health System in Durham County, North Carolina, United States. Different strategies of searching the EMR were explored. Consolidation of results with autopsy reports (nonsearchable in the EMR) and with results from the Durham Veterans' Administration Medical Center was performed to provide a comprehensive report of new VTE from the defined region over a 2-year timeframe.
Monthly searches of the primary EMR missed a significant number of patients with new VTE who were identified by a separate manual search of radiology records, apparently related to delays in data entry and coding into the EMR. Comprehensive searches incorporating a location-restricted strategy were incomplete due to the assigned residence reflecting the current address and not the address at the time of event. The most comprehensive strategy omitted the geographic restriction step and identified all patients with VTE followed by manual review of individual records to remove incorrect entries (e.g., outside the surveillance time period or geographic location; no evidence for VTE). Consolidation of results from the EMR searches with results from autopsy reports and the separate facility identified additional patients not diagnosed within the Duke system.
We identified several challenges with implementing a comprehensive VTE surveillance program that could limit accuracy of the results. Improved electronic strategies are needed to cross-reference patients across multiple health systems and to minimize the need for manual review and confirmation of results.
美国的几个组织已经建议对静脉血栓栓塞症（VTE）进行系统监测。然而，尽管大多数医疗保健提供者和医疗机构都采用了电子病历（EMR），但仍无法进行 VTE 的系统监测。
本文开发了一种针对特定地理区域内 VTE 的全面、基于人群的监测策略。
主要监测策略将计算机搜索 EMR 与北卡罗来纳州达勒姆县杜克大学卫生系统的影像学数据手动复查相结合。探索了不同的 EMR 搜索策略。通过与尸检报告（在 EMR 中无法搜索）和达勒姆退伍军人管理局医疗中心的结果进行整合，提供了在 2 年时间内来自定义区域的新 VTE 的综合报告。
对主要 EMR 的每月搜索错过了大量新 VTE 患者，这些患者通过对放射学记录的单独手动搜索确定，这显然与数据输入和编码到 EMR 中的延迟有关。由于分配的住址反映的是当前地址而不是事件发生时的地址，因此包含位置限制策略的全面搜索并不完整。最全面的策略省略了地理限制步骤，确定了所有随访 VTE 的患者，然后手动复查个人记录以删除不正确的条目（例如，不在监测时间段或地理位置内；没有 VTE 的证据）。对 EMR 搜索结果与尸检报告和单独设施的结果进行整合，确定了在杜克系统内未诊断出的其他患者。
我们发现实施全面 VTE 监测计划存在一些挑战，这可能会限制结果的准确性。需要改进电子策略，以交叉参考多个医疗系统中的患者，并最大限度地减少手动复查和结果确认的需要。
