A survey of validity and utility of electronic patient records in a general practice

Objective To develop methods of measuring the validity and utility of elect ronic patient records in general practice. Design A survey of the main functional areas of a practice and use of indep endent criteria to measure the validity of the practice database. Setting A fully computerised general practice in Skipton, north Yorkshire. Subjects The records of all registered practice patients. Main outcome measures Validity of the main functional areas of the practice clinical system. Measures of the completeness, accuracy, validity, and uti lity of the morbidity data for 15 clinical diagnoses using recognised diagn ostic standards to confirm diagnoses and identify further cases. Developmen t of a method and statistical toolkit to validate clinical databases in gen eral practice. Results The practice electronic patient records were valid, complete, and a ccurate for prescribed items (99.7%), consultations (98.1%), laboratory tes ts (100%), hospital episodes (100%), and childhood immunisations (97%). The morbidity data for 15 clinical diagnoses were complete (mean sensitivity = 87%) and accurate (mean positive predictive value = 96%). The presence of the Read codes for the 15 diagnoses was strongly indicative of the true pre sence of those conditions (mean likelihood ratio = 3917). New interpretatio ns of descriptive statistics are described that can be used to estimate bot h the number of true cases that are unrecorded and quantify the benefits of validating a clinical database for coded entries. Conclusion This study has developed a method and toolkit for measuring the validity and utility of general practice electronic patient records.