Challenges in Identifying Heart Failure Diagnoses from the Electronic Health Record.

Background: To leverage the EHR effectively for clinical operations, quality improvement, and research, patients with a specific clinical condition such as heart failure are often identified through ICD diagnosis codes and structured data. These diagnoses are validated by clinician chart review, which is considered the gold standard for confirming true cases from the EHR. The purpose of the study was to explore obstacles that clinicians encounter when using chart review to validate heart failure diagnoses from the EHR. Methods: In prior work, a team of eight clinicians performed chart review to validate heart failure diagnosis based on the "Universal Definition of Heart Failure." A portion of the charts were reviewed by two independent reviewers, and we assessed inter-rater reliability using Cohen's kappa (κ). We conducted a content analysis of documents from the clinician chart review to understand challenges in validating EHR-based definitions of heart failure. Results: Clinicians reviewed 528 charts, with a κ of 0.62 among the 35% of charts with double review. In qualitative analysis, we identified two overarching themes related to challenges in validation of heart failure: 1) challenges in applying the Universal Definition of Heart Failure to real-world patient data, and 2) EHR interoperability and usability barriers impacting validation of heart failure diagnoses. Conclusions: Our study highlights clinical and technological limitations of clinician chart review for identifying heart failure patients. This has implications for patient care, quality improvement, and population health. Policies and digital solutions aimed at improving EHR data collection, organization, and data extraction are needed.