Assessment of the Quality of Electronic Information Retrievable by MedARKS® for the Evaluation of Atoxoplasmosis in Bali Mynahs (Leucopsar rothschildi)
In order to evaluate the potential to conduct population-based disease studies using medical data captured by the MedARKS® system, a library disk containing records from 338 Bali mynahs (Leucopsar rothschildi) from 55 institutions was evaluated with regards to atoxoplasmosis. Data were exported from the library file to Excel® worksheets, which were subjectively analyzed for usefulness, and pertinent data were imported to a relational database (Access 97®) to further evaluate the data. Data were summarized, including total number of birds tested; types of deaths; and type, results, dates and purpose of parasitology tests. To assess the correctness of the data, records were queried for non-standard entries, unclear results, inaccuracies, ambiguities, and nonspecific tests. To assess the consistency of the data, comparisons were made between the problem list and positive tests in the parasitology module, and between the listings of buffy coat smears in the clinical pathology module and the parasitology module.
A total of 2428 parasitology records were evaluated. The number of uninterpretable results from inaccuracies (from misspellings or conflicting test results) and/or unclear results (due to nonspecific results, such as “low numbers of oocysts”) was 81 (3.3%). Nine records were missing from the parasitology module, and 85 (3.5%) records did not include tests/results. Thirty-four different terms were used to denote “positive for Atoxoplasma sp.”. Some discrepancies were found where atoxoplasmosis was listed as a problem but not related to a parasitology result (11; 0.5%), and where a bird was positive for Atoxoplasma sp. but not included in the problem list (56; 2.3%). Buffy coat data were inconsistent between the clinical pathology and the parasitology modules.
Overall, while the Bali mynah data appeared clinically useful and sufficient functionality exists within MedARKS® to capture epidemiological data, the current usage of the system at most institutions makes it challenging to efficiently undertake population-based analysis due to variation in usage and data entry. These limitations are not unique to MedARKS® but are common to many clinical medical record programs. Specific challenges raised with these data include: 1) reliance by many solely on free text-based data entry, 2) incomplete use of a common library database or codes not accurately defined and used, and 3) difficult correlation of individual animal data back to source institution, and 4) inconsistent transfer of records from paper into the database. By evaluating the quality of data concerning atoxoplasmosis in Bali mynahs in MedARKS®, we hope these issues may assist in the further development of recommendations for use of the existing system and for future system designs.