A Step By Step Guide to Self Service Chart Review

Step 1 - Research Compliance and Privacy Approvals

In order to create a list of patients (also known as a "cohort" of patients) for online chart review, you need to have contacted the Stanford Research Compliance Office.

     Prep to Research: If you are still in the preparatory to research phase, you can provision yourself a chart review up to 50 de-identified charts, available for 90 days.
     Research: If your intent is research, you must have an approved IRB protocol.
     Clinical QI: If your intent is not research, you must obtain a determination of Non Human Subjects (NHS) from the Research Compliance Office in order to use this self-service tool.

Everyone on the research team must individually attest that they are wiling to assume and honor the data privacy obligations that come with working with clinical data for research. If your IRB already has a primary DPA completed by someone else on the team, you must add your attestation to the existing approved primary attestation as described on our Add-On Privacy Attestation page.

Step 2 - Cohort Definition

After you have your compliance matters settled, the next step is taken in the Cohort Discovery Tool.

Before you can review patient charts online for research purposes, you must first specify which patients whose charts you wish to review.

You can rapidly build an ad hoc patient phenotype definition using the Cohort Discovery Tool to characterize the patients of interest. Drag suitable search constraints from the left hand toolbox into the query builder on the right. Detailed instructions are available in the Cohort Discovery Tool Users' Guide. Once you have a suitable search query defined, select "Save for Chart Review" from the dropdown menu under the "Counts" toolbar button in the upper right.

Alternately, if you have a list of MRNs, e.g. from a research database such as REDCap, you can use it to specify your patient list for chart review by selecting "Upload MRNs for Chart Review" from the Cohort Discovery Tool using the dropdown menu under the "Counts" toolbar button in the upper right.

MRNs for Chart Review

Please note that we limit the size of chart review cohorts to 1,500 patients. All patient information is transferred to your web browser, and with more than around 1,500 patients, you are very likely to run your browser out of memory.

Step 3 - Name Your Cohort and Specify IRB, PHI, and Collaborators

When you save your list, you will see a dialog box prompting you for

  1. the cohort name 
  2. your IRB number
  3. what PHI is minimally necessary, and
  4. who else will be assisting you with the chart review

Take note of the four checkboxes in the PHI section; if you leave these unchecked, your cohort will be de-identified. This can be very handy e.g. when students are helping with chart review, as it does allow them to work with the minimum necessary PHI.

When you complete filling in the form and click "Create Cohort", you will be prompted to either continue searching for cohorts or switch to chart review.

If you already have charts to review, in order to get the new menu item to appear the first time you may have to refresh your browser window.

For other troubleshooting tips at this stage or any other part of the process, please refer to our Frequently Asked Questions page.

Step 4 - Read the User's Guide

It is well worth the effort to scan through the Chart Review Tool User Guide, as it describes several time-saving features that are worth knowing about.

Step 5 - Review Charts, Flagging as you go

As described in the Users's Guide, you can tag patients who do and do not meet your inclusion criteria. You can then use these tags to filter data for download.

Step 6 - Download your data

Some research projects can benefit from a data download. Use the "Create Download Files" button in the upper right to generate. Note that particularly for large cohorts the download file generation process can take a long time. When complete, a list of available files will appear in the upper right. 

Further Information

Please consult our FAQ if you have any further questions.