Possibilities and reserves of using electronic medical records data in health information systems on the example of assessing the causes of visits to outpatient clinics and death in patients with acute forms of coronary artery disease

Aim. To study the possibilities of using electronic medical records in health information systems (HIS) to assess the demographic characteristics and nosological causes of visits to outpatient clinics and death (using myocardial infarction (MI) as an example).

Material and methods. This retrospective study was conducted based on the registration of anonymized personalized data of electronic medical records from HIS of the Moscow Region and data on the underlying cause of death provided by the General Civil Registry Office of the Moscow Region. A total of 2357 people with acute MI in 20202021, which was the reason for visiting the clinic and/or the cause of death in 2021, were included in the study. Depending on the reason for visiting an outpatient clinic/the underlying cause of death, the study participants were divided into 4 following groups: group 1 — any cause except coronary artery disease (CAD) and MI/MI; group 2 — CAD but not MI/MI; group 3 — MI/not MI; group 4 — MI/MI. Statistical analysis was performed using the SPSS-26.0 program.

Results. The mean age at death in group 2 was significantly higher than in groups 1, 3 and 4 (p<0,001). In all groups, the mean age at death in women was significantly higher than in men (p<0,001). The mean number of visits to outpatient clinics was highest among patients in group 3 (p<0,001). Among 1976 patients who died from MI in 2021 and had previously visited the clinic in 2020-2021 (groups 1, 2, 4), in 71,4% of cases the reason for visiting was not CAD. In 92 (3,9%) patients, MI was the reason for visiting in 2020-2021 and the initial cause of death in 2021, while in 1404 (59,6%) patients who did not visit for CAD or MI in 2020-2021, MI was the initial cause of death in 2021. Following data recording errors were revealed: only in 28 (12,7%) of 219 cases after MI were codes recommended in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) for recording cases of post-infarction cardiosclerosis (I25.8) indicated; in 326 (16,5%) cases among those who died from MI, codes I22.0-9 were used, which are not recommended to be indicated as the underlying cause of death. Almost half of the cases indicated codes for MI of unspecified location. In group 1, diseases such as hypertension, cancer, and diabetes were registered less frequently. The proportion of cerebrovascular diseases was the lowest among patients in group 4. Hypertension, cerebrovascular diseases, acute cerebrovascular accident, cancer and COVID-19 were most frequently detected among patients in group 3, while diabetes was most frequently found in participants in group 2.

Conclusion. The study results indicate barriers and problems in the use of accumulated data arrays in HIS. The data obtained confirm the need to develop measures aimed at standardization, structuring and a single regulatory system for entering data on the reasons for patient visits to outpatient clinics and the causes of their death in HIS. It also indicates the relevance of research analysis of HIS information in order to improve the stratification of the risk of adverse outcomes and increase the effectiveness of treatment and preventive care at the outpatient stage.

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