NEAUA - Using Electronic Health Records Data in Practice Audit: Ureteroscopy- Stent or No Stent?

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Using Electronic Health Records Data in Practice Audit: Ureteroscopy- Stent or No Stent?
Emmanuel Abara, FRCSC, FACS, FICS.
Richmond Hill Urology Practice & Prostate Institute, Richmond Hill, ON, Canada.

Background: Ureteroscopy is commonly used in the management of stone and other diseases of the ureter. The use of stent before and after ureteroscopic lithotripsy remains controversial. Electronic Health Records (EHR) , a software platform that contains data captured during patient-health care professional encounter has become ubiquitous. It is useful for billing but other applications in research, data analysis, practice audit and quality improvement are gaining momentum. In 2013, we adopted the use of Electronic Health Record(EHR) as recommended and supported by the Ontario MD in collaboration with the Ministry of Health and Long-Term Care.
Aim : The purpose of this study is to understand the basic ways of manipulating EHR data to identify “hot spots” in ureteral stone management and describe the treatment outcomes in a community urology practice.
Materials and Methods: Data recorded in the physician’s clinical notes, operative room records including details of procedure and fluoroscopy times and follow up were reviewed and extracted. Tracking of the procedures were verified using the OHIP/MOHLTC Diagnostic and Billing codes. For question formation and sequencing, a literature search( English) was completed through PUBMED, Medline, Cochrane Data base using such words and phrases as EHR Ureteroscopy Stent or No Stent, EHR Ureterosopy, EHR Data analysis. Data collection was between 2001 and 2004 and these included patient’s age , sex, stone features, stent or no stent , operating and fluoroscopy times, whether booked electively or admitted through the ER. Data extracted were then transferred into a random number spread sheet function to assist with analysis.
Results: There were 192 procedures - 149 ‘Stent’ and 43 ‘No Stent’ ,ratio 3:1.These two groups were comparable regarding patients , stone characterestics, stone free rates , infections and complications .The mean stone size was 8.5+/-2mm.Stone free rates at 6 weeks was 100% in each group. There was relief of renal colic in all patients immediately. After 2 days, lower urinary tract symptoms (LUTS) were significantly less in patients with ‘no stent’ compared to those who were stented. Our findings appear to be similar with published data in the literature.
Conclusion: Data extraction and manipulation from the EHR was successful . In addition to billing purposes, EHR application in research , chronic disease management, quality improvement and practice audit is attractive and will grow.

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