Evaluating the Fitness for Purpose of Primary Care Data from Emrs for Automated Antimicrobial Prescribing Audits

Abstract

OBJECTIVETo assess the fitness for purpose of primary care data from electronic medical records (EMRs) for the development of automated algorithms for antimicrobial quality of prescribing auditing.MATERIAL AND METHODSThis is a cross-sectional descriptive study to assess the data quality of antimicrobial auditing-related fields in Patron, a large Australian primary care EMR dataset containing de-identified data from three different EMR systems with 3.5 million patients from 129 consenting general practices using The Harmonized Data Quality Assessment Terminology and Framework.RESULTSResults from the data conformance, uniqueness, and plausibility assessments demonstrated that data were generally of high quality and may be fit for the development of automated algorithms for antimicrobial auditing. An identified possible shortcoming of this dataset was in completeness in certain fields. The major contributor to this was differences between the data fields available in each of the contributing systems.CONCLUSIONThis research provides insight into the fitness for purpose of primary care EMR data for automated algorithms for antimicrobial auditing. Results also highlight the strengths of data curated by a specialist general practice research information technology unit and draws attention to issues surrounding data fragmentation between systems due to an absence of standardization in data capture protocols in this setting.OBJECTIVETo assess the fitness for purpose of primary care data from electronic medical records (EMRs) to develop automated algorithms for antimicrobial quality of prescribing auditing using The Harmonized Data Quality Assessment Terminology and Framework[1].BACKGROUND AND SIGNIFICANCEOptimizing the use of antimicrobials for the treatment and prevention of infections is a foundational requirement to address the global health threat of antimicrobial resistance (AMR), which is a recognized leading cause of death[2]. In Australia, the National Antimicrobial Resistance Strategy acknowledges AMR as a significant concern and has incorporated “better antimicrobial stewardship (AMS)” as one of its four pillar objectives in all health care settings as part of this strategy[3]. AMS is a coordinated approach to promote and increase the appropriate use of antimicrobials[4,5]. Despite the high rate of antimicrobial prescribing in primary care[6-8] and the multitude of documents produced by national bodies stipulating AMS activities for primary care providers[9,10], there is still no dedicated federal funding for AMS services in this setting. Additionally, coordinated and sustainable systems do not exist, and there is an overall absence of oversight of antimicrobial prescribing quality in primary care.

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Funding declaration: DC, JMN, KT, RB, RC, and VR have received funding from the Commonwealth of Australia, Department of Health and Aged Care, grant number MRFFRD000113. RC also receives funding from The National Centre for Antimicrobial Stewardship at The University of Melbourne.

Conflict of Interests: DB is the current Data Steward for Patron and JMN was the previous Responsible Researcher for the Patron dataset at The University of Melbourne. All other authors declare no competing interests.

Ethical Approval: This study had University of Melbourne Human Research Ethics Committee approval (Ethics ID 2023-25511-41897-3) and approval from the independent Patron Data Governance Committee to use deidentified data from the Patron repository for this research.

Keywords: Primary Care, EMR, EHR, Antimicrobial Stewardship, AMR