Recharacterizing Medical Marijuana Documentation within Electronic Health Records: Use of a Customized Smart Data Element and Evaluation with a Systematic Chart Review Protocol (Preprint)

Abstract

Medical Marijuana (MMJ) is available in Pennsylvania and participation in the state-regulated program requires a patient to register and receive a certification by an approved physician. There is currently no integration of MMJ certification data in Pennsylvania into health records that would allow for physicians to rapidly identify patients that are using MMJ, as there are with other scheduled drugs. This absence of a formal data sharing structure necessitates tools that aid in consistent documentation practices to enable comprehensive patient care.

Customized smart data elements (SDE) were made available to clinicians at an integrated health system, Geisinger, following MMJ legalization in Pennsylvania. The purpose of this project was to examine and contextualize the use of MMJ SDEs in the Geisinger population. We accomplished this goal by developing a systematic chart review protocol, with the goal of creating a tool that resulted in consistent human data extraction.

We developed a chart review protocol for extracting MMJ-related information. The protocol was developed between August to December of 2022 and focused on a patient group that received one of several MMJ SDE between 1/25/2019 and 5/26/2022. Characteristics were first identified on a small pilot sample of patients (N=5), which were then iteratively reviewed to optimize for consistency. Following the pilot, two reviewers were assigned 200 patient charts, selected randomly from the larger cohort, with a third reviewer examining a subsample to determine reliability. We then summarized the clinician-level and patient-level features from n=156 charts with a table-format SDE that best captured MMJ information.

We found the chart review protocol was feasible for those with minimal medical background to complete, with high inter-rater reliability (Kappa = 0.966 (p <0.001), 95% CI (0.954 - 0.978)). MMJ certification was largely documented by nurses and medical assistants (87.2%) and typically within primary care settings (68.6%). The SDE has 6 pre-set field prompts, including certifying provider, authorized dispensary, certifying conditions, dosage, product, and active ingredient. We found preset fields were overall well-recorded (76.6% across all fields). Individual fields were more heterogeneous in terms of completion, with dispensary specified in 87.8% of documentation, certifying provider specified in 61.5% of documentation, and product dose specified in only 30.8% of documentation.

This method of chart review yields high quality data extraction that can serve as a model for other health record inquiries. Our evaluation showed relatively high completeness of SDE fields, primarily by clinical staff responsible for rooming patients. Improving adoption and fidelity of SDE data collection may present a valuable data source for future research on patient MMJ use and treatment efficacy and outcomes.

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