Better Data Collection Key to Address EHR, Claims Data Discordance
There is a moderate agreement between EHR data and Medicare Part D (MPD) claims data for the receipt of oral anticancer agents, which are a popular treatment option for cancer patients, according to a study published in JAMA Network Open.
The study, conducted by the Texas Cancer Registry and The University of Texas MD Anderson Cancer Center (MDACC), found that 73.8 percent of the EHR data and MPD claims data overlapped, with 176 data sets shown in both and 123 sets not shown for either.
Oral anticancer agents are becoming more popular and equally as expensive, leaving policymakers to uncover data about how patients use them, which then allows for regulatory decision making.
Because the agreement percentage was moderate, this makes it tough on lawmakers to establish accurate reimbursement models or other health policies.
“The moderate rate of agreement (ie, 73.8 percent) found in this study may be because of various reasons,” wrote the authors of the study. “The EHR may be missing oral anticancer use for patients receiving only a consultation or because of incomplete medication reconciliation or medical record information. Claims in MPD may be missing because patients could obtain medications by other means that do not result in an MPD claim, including discount or other assistance programs.”
This study looked at 170 Medicare Part D members age 65 years or older at MDACC who had breast, prostate, kidney, or colon cancer or chronic myeloid leukemia. The analysis looked at 208 EHRs and 250 Part D claims from between 2007 and 2012.
Researchers examined both the intricacies of the EHR and the MPD claims data to identify any use of an oral anticancer agent. Because this specific EHR did not have a prescription order entry, researchers examined the MPD claims data to see if the prescriptions were filled.
Disagreement occurred 26.2 percent of the time. Seventy-four MPD claims (18.3 percent) were not found in the EHR, and 32 EHR drugs (7.9 percent) were not found in the MPD.
The researchers assessed 22 different oral anticancer drugs in total. These drugs included, bicalutamide (observed in 74 MPD records and 54 EHRs), anastrozole (in 36 MPD records and 34 EHRs), and pazopanib (in 25 MPD records and 18 EHRs).
MDACC researchers noted past research on the topic that signified overlap rates with “κ” statistics after matching the name of the drug and treatment dates.
For example, there was a 96 percent overlap rate with a κ of 0.72 between a tumor registry and medical records for tamoxifen or aromatase-inhibitors for breast cancer.
This latest study revealed similar findings, but posed another statistical analysis for doing so.
In an effort to improve data quality that could be used in regulatory decision making, the authors said data linkage between the EHR and administrative claims could possibly make it easier to assess drug exposures and outcomes.
Enhancing regulatory decision making will allow patients to gain better access to safe and effective medical products. Leveraging both EHR data and administrative claims could make this happen.
“This study provides an estimate of the potential information difference that may be present when EHR or claims data alone are used, with important implications for studies of oral anticancer drug use patterns, drug spending, outcomes, and quality measures,” the authors wrote.
“For the drugs that are in the EHR but are missing from MPD (8 percent), there is concern regarding how to fully evaluate the use of costly anticancer drugs using MPD data. For the drugs that are in the MPD but are missing in EHR (18 percent), there is concern regarding the completeness of utilization patterns that are generated based on EHR.”