Management
Performing extensive review of EHR data for each patient was impractical. The process was labor-intensive and defeated the intent of a pragmatic trial. Therefore, data-driven reviews were undertaken to ensure data quality, conducting either through systematic adjudication of crosswalk tables or using a site-specific random-sampling approach.The adjudication of the hydrochlorothiazide drug list was an example of a systematic review. Updates to the medication lists were performed yearly by the VA EHR vendor. These were electronic listings captured by CDW to document prescriptions supplied at the VHA facilities. Based on the frequency of update, annual review was performed by study nurses, to include new variations of drug names or doses to the extraction algorithm.A random-sampling review approach was used to verify PCC and patient contact. This was done before applying the electronic workflows to a specific VA primary care network. Project nurses performed medical record review on a small sample, to verify contact information against data shown in CDW. This was necessary because information might be formatted differently across regional systems, yielding invalid recipient names or addresses pulled by the automated process. This preserved time from sorting returned mails and confirming that patients received appropriate notification letters.Results originating from EHR data might be structured differently across primary care networks, even though the PCC orders were predefined and entered consistently. This resulted in the need to manually track PCC discontinuation and approval orders. For example, the organization of PCC orders might vary slightly between networks. When this occurred, the ETL process was unable to search for strings that contained the predefined text.