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Abstract 271: An Electronic, Point-of-Care Cath Lab Clinical Application Provides High Validity, Completeness, and Timeliness Compared to Traditional Medical Charting


 Background:
 Beginning in 2005, an electronic, point-of-care clinical application (CART-CL) was implemented in all 78 VA cardiac catheterization laboratories. CART-CL collects pre-procedural and procedural data in a standardized format that is recorded in the VA electronic health record. This application was created to support quality improvement, but the validity, completeness, and timeliness of these data, relative to a standard medical record are unknown.
 
 
 Methods:
 In a random sample of 10 VA catheterization labs, we abstracted a standardized set of key data elements (based on the National Cardiovascular Data Repository mortality model) from the reports of catheterization procedures. At each site, we selected 10 procedures performed before CART-CL adoption and 10 after adoption for comparison. Notes from procedures performed before CART-CL adoption were entered directly into VISTA/CPRS, VA’s electronic health record. Validity was assessed by comparing data elements recorded in notes generated by CART-CL versus VISTA/CPRS. Completeness was assessed using a standardized list of data elements. Timeliness was defined as the percentage of catheterization reports available to the treating provider on the day of the procedure.
 
 
 Results:
 The 200 cases selected were evenly distributed between elective and ACS indications. Of the 1690 observations abstracted from CART-CL-generated notes and analyzed for validity, 1664 (98.5%) were valid. Only 7 data elements had less than 100% validity with lowest validity found in diabetes medications (94%) and statin dose (84%). Two thousand five hundred eighty-one of 3276 (79%) data elements in CART-CL were complete, as compared with 2098 of 3323 (63.1%) data elements in CPRS charts before CART-CL implementation (p-value < 0.0001). The number of data elements analyzed for validity and completeness differed due to varying prevalence of conditions and procedures within the study population. Seventy-one percent of CART-CL catheterization reports were available to treating providers the day of the procedure, as compared with 58.0% of VISTA/CPRS catheterization notes before CART-CL adoption (p-value = 0.055). Among those reports not available on the day of the procedure, the median time-to-availability was not significantly shorter after adoption of CART-CL than before (3.0 vs. 5.0 days, p-value = 0.887).
 
 
 Conclusions:
 CART-CL is an electronic, point-of-care clinical application that collects VA cath lab patient and procedural information in a standardized fashion. Compared to the previous method of medical charting, it has high validity, and superior completeness and timeliness. Accordingly, it can serve as an effective quality assessment tool for cath labs.
