J Am Med Inform Assoc 19:e96-e101 doi:10.1136/amiajnl-2011-000536
  • Research and applications
  • FOCUS on clinical research informatics

Use of electronic health record data to evaluate overuse of cervical cancer screening

  1. David W Baker1
  1. 1Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  2. 2Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  1. Correspondence to Dr Jason S Mathias, Health Services Research Fellow, Institute for Healthcare Studies, Feinberg School of Medicine, Division of General Internal Medicine, 750 North Lakeshore Drive 10th Floor, Chicago, IL 60611, USA; j-mathias{at}
  1. Contributors All authors made substantial contributions to the conception and design of this work, acquisition and interpretation of the data, and writing of the manuscript. All authors reviewed the final version of the manuscript as submitted and approve it for publication. All those who are qualified to be authors are listed in the byline.

  • Received 10 August 2011
  • Accepted 17 December 2011
  • Published Online First 19 January 2012


Background National organizations historically focused on increasing use of effective services are now attempting to identify and discourage use of low-value services. Electronic health records (EHRs) could be used to measure use of low-value services, but few studies have examined this. The aim of the study was to: (1) determine if EHR data can be used to identify women eligible for an extended Pap testing interval; (2) determine the proportion of these women who received a Pap test sooner than recommended; and (3) assess the consequences of these low-value Pap tests.

Methods Electronic query of EHR data identified women aged 30–65 years old who were at low-risk of cervical cancer and therefore eligible for an extended Pap testing interval of 3 years (as per professional society guidelines). Manual chart review assessed query accuracy. The use of low-value Pap tests (ie, those performed sooner than recommended) was measured, and adverse consequences of low-value Pap tests (ie, colposcopies performed as a result of low-value Pap tests) were identified.

Results Manual chart review confirmed query accuracy. Two-thirds (1120/1705) of low-risk women received a Pap test sooner than recommended, and 21 colposcopies were performed as a result of this low-value Pap testing.

Conclusion Secondary analysis of EHR data can accurately measure the use of low-value services such as Pap testing performed sooner than recommended in women at low risk of cervical cancer. Similar application of our methodology could facilitate efforts to simultaneously improve quality and decrease costs, maximizing value in the US healthcare system.


  • An earlier version of the manuscript was presented as a poster at the Society of General Internal Medicine Annual Meeting in Minneapolis, MN in 2010 and as an oral presentation at the Academy Health Annual Research Meeting in Seattle, WA in 2011.

  • Funding JSM's fellowship is funded by AHRQ grant 5T32HS000078-13. The project is not supported in any other way.

  • Competing interests None.

  • Ethics approval IRB of Northwestern University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Study protocol and limited data available on request from Dr Jason S Mathias (email, jasonmathi{at}

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