Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study

Katharine M Mark, Daniel Leightley, David Pernet, Dominic Murphy, Sharon A M Stevelink, Nicola T Fear, Katharine M Mark, Daniel Leightley, David Pernet, Dominic Murphy, Sharon A M Stevelink, Nicola T Fear

Abstract

There is a lack of quantitative evidence concerning UK (United Kingdom) Armed Forces (AF) veterans who access secondary mental health care services-specialist care often delivered in high intensity therapeutic clinics or hospitals-for their mental health difficulties. The current study aimed to investigate the utility and feasibility of identifying veterans accessing secondary mental health care services using National Health Service (NHS) electronic health records (EHRs) in the UK. Veterans were manually identified using the Clinical Record Interactive Search (CRIS) system-a database holding secondary mental health care EHRs for an NHS Trust in the UK. We systematically and manually searched CRIS for veterans, by applying a military-related key word search strategy to the free-text clinical notes completed by clinicians. Relevant data on veterans' socio-demographic characteristics, mental disorder diagnoses and treatment pathways through care were extracted for analysis. This study showed that it is feasible, although time consuming, to identify veterans through CRIS. Using the military-related key word search strategy identified 1600 potential veteran records. Following manual review, 693 (43.3%) of these records were verified as "probable" veterans and used for analysis. They had a median age of 74 years (interquartile range (IQR): 53-86); the majority were male (90.8%) and lived alone (38.0%). The most common mental diagnoses overall were depressive disorders (22.9%), followed by alcohol use disorders (10.5%). Differences in care pathways were observed between pre and post national service (NS) era veterans. This feasibility study represents a first step in showing that it is possible to identify veterans through free-text clinical notes. It is also the first to compare veterans from pre and post NS era.

Keywords: United Kingdom; electronic health records; feasibility study; mental health; national health service; secondary mental health care; veterans.

Conflict of interest statement

S.A.M.S.’ salary is partly paid by the National Institute for Health Research Biomedical Research Centre at the SLaM NHS Foundation Trust and King’s College London. NTF and SAMS are partly funded by the Ministry of Defence. NTF sits on the Independent Group Advising on the Release of Data at NHS Digital. NTF is also a trustee of a veterans’ charity. The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the UK Ministry of Defence.

Figures

Figure 1
Figure 1
Hit rates for the three primary military search terms used in Clinical Record Interactive Search system—“Royal Navy”, “Army” and “Royal Air Force”.

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