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Evaluation of Use of Technologies to Facilitate Medical Chart Review

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Abstract

Introduction

While medical chart review remains the gold standard to validate health conditions or events identified in administrative claims and electronic health record databases, it is time consuming, expensive and can involve subjective decisions.

Aim

The aim of this study was to describe the landscape of technology-enhanced approaches that could be used to facilitate medical chart review within and across distributed data networks.

Method

We conducted a semi-structured survey regarding processes for medical chart review with organizations that either routinely do medical chart review or use technologies that could facilitate chart review.

Results

Fifteen out of 17 interviewed organizations used optical character recognition (OCR) or natural language processing (NLP) in their chart review process. None used handwriting recognition software. While these organizations found OCR and NLP to be useful for expediting extraction of useful information from medical charts, they also mentioned several challenges. Quality of medical scans can be variable, interfering with the accuracy of OCR. Additionally, linguistic complexity in medical notes and heterogeneity in reporting templates used by different healthcare systems can reduce the transportability of NLP-based algorithms to diverse healthcare settings.

Conclusion

New technologies including OCR and NLP are currently in use by various organizations involved in medical chart review. While technology-enhanced approaches could scale up capacity to validate key variables and make information about important clinical variables from medical records more generally available for research purposes, they often require considerable customization when employed in a distributed data environment with multiple, diverse healthcare settings.

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Acknowledgements

The authors would like to acknowledge the contributions of Sentinel Data Partners and organizations involved in medical chart review who participated in this project.

Author information

Authors and Affiliations

  1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA

    Loreen Straub, Joshua J. Gagne & Shirley V. Wang

  2. Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA

    Judith C. Maro, Nicolas Beaulieu, Jeffrey S. Brown, Adee Kennedy & Margaret Johnson

  3. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA

    Michael D. Nguyen

  4. Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Adam Wright & Li Zhou

Authors
  1. Loreen Straub
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  2. Joshua J. Gagne
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  3. Judith C. Maro
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  4. Michael D. Nguyen
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  5. Nicolas Beaulieu
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  6. Jeffrey S. Brown
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  7. Adee Kennedy
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  8. Margaret Johnson
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  10. Li Zhou
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  11. Shirley V. Wang
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Contributions

LS and SVW wrote the manuscript, performed the research and analyzed the data; all authors designed the research and revised the manuscript.

Corresponding author

Correspondence to Loreen Straub.

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Conflict of interest

Joshua J. Gagne has received salary support from grants from Eli Lilly and Company and Novartis Pharmaceuticals Corporation to the Brigham and Women’s Hospital and is a consultant to Aetion, Inc. and Optum, Inc., all for unrelated work. Shirley V. Wang receives salary support from investigator-initiated grants from Novartis, J & J, and Boehringer Ingelheim to the Brigham and Women’s Hospital and is a consultant to Aetion, Inc., all for unrelated work. Loreen Straub, Judith C. Maro, Michael D. Nguyen, Nicolas Beauileu, Jeffrey S. Brown, Adee Kennedy, Margaret Johnson, Adam Wright and Li Zhou declare that they have no conflict of interest.

Funding

The Sentinel System is sponsored by the US Food and Drug Administration (FDA) to proactively monitor the safety of FDA-regulated medical products and complements other existing FDA safety surveillance capabilities. The Sentinel System is one piece of FDA’s Sentinel Initiative, a long-term, multi-faceted effort to develop a national electronic system. Sentinel Collaborators include Data and Academic Partners that provide access to healthcare data and ongoing scientific, technical, methodological, and organizational expertise. The Sentinel Coordinating Center is funded by the FDA through the Department of Health and Human Services (HHS) Contract number HHSF223201400030I. This project was funded by the FDA through HHS Mini-Sentinel contract number HHSD22301002T. This article reflects the views of the authors and should not be construed to represent FDA’s views or policies.

Research involving human participants and/or animals

This article presents information collected via semi-structured interviews with organizations who agreed to participate in this project and does not contain any active studies with human participants or animals performed by any of the authors.

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Straub, L., Gagne, J.J., Maro, J.C. et al. Evaluation of Use of Technologies to Facilitate Medical Chart Review. Drug Saf 42, 1071–1080 (2019). https://doi.org/10.1007/s40264-019-00838-x

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  • DOI: https://doi.org/10.1007/s40264-019-00838-x

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