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Computerized Adjudication of Coronary Heart Disease Events using the Electronic Medical Record in HIV Clinical Research: Possibilities and Challenges Ahead.

OBJECTIVE
This pilot study assessed feasibility of computer-assisted Electronic Medical Record (EMR) abstraction to ascertain coronary heart disease (CHD) event hospitalizations.


METHODS
We included a convenience sample of 87 hospitalization records from participants at University of North Carolina's (UNC's) Women's Interagency HIV Study (WIHS) and Center for AIDS Research (CFAR) HIV Clinical Cohort hospitalized at a UNC-affiliated hospital from July 2004 - July 2015. We compared a computer algorithm utilizing diagnosis/procedure codes, medications, and cardiac enzyme levels to adjudicate CHD events (myocardial infarction (MI)/coronary revascularization) from the EMR to standardized manual chart adjudication.


RESULTS
Of 87 hospitalizations, 42 were classified as definite, 25 probable, and 20 non-CHD events by manual chart adjudication. A computer algorithm requiring presence of ≥1 CHD-related ICD-9/CPT code correctly identified 24 of 42 definite (57%), 29 of 67 probable/definite CHD (43%), and 95% of non-CHD events; additionally requiring clinically-defined cardiac enzyme levels or administration of MI-related medications correctly identified 55%, 42%, and 95% of such events, respectively. Requiring any one of the ICD-9/CPT or cardiac enzyme criteria correctly identified 98% of definite, 97% of probable/definite CHD, and 85% of non-CHD events. Challenges included difficulty matching hospitalization dates, incomplete diagnosis code data, and multiple field names/locations of laboratory/medication data.


CONCLUSION
Computer algorithms comprising only ICD-9/CPT codes failed to identify a sizable proportion of CHD events. Using a less restrictive algorithm yielded fewer missed events but increased the false-positive rate. Despite potential benefits of EMR-based research, there remain several challenges to fully computerized adjudication of CHD events.