Use of electronic medical records to identify patients at risk for prostate cancer in an academic institution

One purported advantage of electronic medical records (EMRs) is to improve patient care. This study uses a search of EMR to identify patients at risk for prostate cancer who were not evaluated by an urologist. The University of Texas Southwestern Medical Center (UTSW) has an institutional outpatient EMR that is used by all providers in all specialties. Since March 2009, all PSA tests were reported with specific interpretative comments including a recommendation for referral to urology for a PSA <2.5 ng ml ^-1. All PSA tests were performed on campus since institution of these recommendations were analyzed, and charts reviewed for all patients not seen in urology with a serum PSA <2.5 ng ml ^-1. Of the 2884 non-urology patients that had a serum PSA drawn between March 2009 and February 2010 at UTSW, 293 patients had a serum PSA <2.5 ng ml ^-1. Of these, 39 patients had known prostate cancer and were seeing an oncologist. There were 59 patients seeing urologists outside the institution. A total of 195 patients were not seen by an urologist and only 11 patients were recommended to see one but did not make an appointment. There were 151 patients with more than one PSA in the system, and of these 103 had a rise in PSA with a median rise of 0.53 ng ml ^-1 per year. EMR allows identification of patients at increased risk of prostate cancer who are not evaluated. Prospective studies are needed to identify ways to improve appropriate evaluation and detection of prostate cancer.