Discordance between Emergency Department Electronic Health Record and Patient Self-Reported Data

Abstract

Electronic Health Records (EHRs) have many clinical, financial, and logistical benefits, yet the extent of their accuracy is unknown. We compared patient self-reported data at emergency department (ED) presentations with the corresponding EHR, focusing on key demographics, physical characteristics, and social history. Emphasis was placed on understanding whether major life stressors were noted on patients’ charts and how that could impact quality of care. Life stressors are defined as life-altering and emotionally demanding or traumatic events. We enrolled a convenience sample of 357 ambulatory, English speaking, adult patients at the Vanderbilt University Medical Center Emergency Department, an urban, academic, tertiary care ED (annual census 70,000). We compared the EHR with self-reported data from bedside patient interviews, including information on demographics (age, sex, race, ethnicity), physical characteristics (height, weight), and life history (smoking, life stressors). Data was described using median and percent frequency, and it was analyzed using Cohen kappa statistics and Bland-Altman plots. Between EHR and patient-reports, sex and age matched in 99%, and race/ethnicity matched in 90%. Race was more discordant when the patient self-identified as multiple races, as it was only reflected in 24% of those patients’ EHRs. Weight, height, and smoking were similar between patient interviews and EHR. Of 281 self-reported life stressors, only 75 were recorded in the EHR. Although most demographic and clinical data were concordant, life stressors were frequently absent from the EHR which suggests a discrepancy in data collection and maintenance.