JMIR Publications

ABSTRACT

Background:

Medical record review (MRR) is a common research method that uses information recorded in patient health records to answer health-related questions. MRRs help researchers learn about disease prevalence and practice patterns, treatment variation, outcomes, and healthcare quality and safety. It is relatively inexpensive and can be conducted efficiently. However, challenges such as missing data, inaccurate terminology, and inconsistent documentation are potential sources of bias, undermining the validity of MRRs. Prior MRR checklists are limited due to being outdated, incomplete, or not designed for newer approaches such as those involving electronic health records (EHRs).

Objective:

To develop expert-approved recommendations and a checklist for the conduct and reporting of MRRs addressing both traditional chart reviews and contemporary EHR-based research.

Methods:

We will conduct an expert consensus study using a modified Delphi approach following the ACCORD guideline for consensus methods in biomedicine. The process will be informed by a systematic review of the literature on the conduct, reporting, and quality assessment of MRR studies, registered on the Open Science Framework website (https://osf.io/9yj8r/overview). A multidisciplinary panel of 27 experts, primarily drawn from but not restricted to the Pediatric Emergency Research Canada (PERC) network and was selected purposefully to ensure diversity in expertise, background, and experience. Candidate checklist items identified through the literature review and an initial meeting will be evaluated over up to three rounds of anonymous online Delphi surveys using 5-point Likert scales. Items not reaching consensus (<75% approval) will be revised iteratively. A steering committee will oversee the process, and an in-person consensus meeting will be held to refine draft guidelines. Approval of the final version of the recommendations by at least 90% of the experts will be required. The final version will be tested with a broader group of patient partners, international researchers and stakeholders to ensure it is practical and useful. Based on institutional policies, this project was considered outside the mandate of the Research Ethics Board and therefore did not require ethics approval.

Results:

This project received financial support from the Canadian Institutes of Health Research (Planning and Dissemination Grant# 204652) in November 2025. The first three rounds of Delphi surveys were conducted in December 2025 to March 2026. The recommendations are expected to be completed in the Spring of 2026 and be externally evaluated in the summer of 2026.

Conclusions:

This project will lead to more rigorously designed MRR studies, thereby improving the quality of healthcare research to inform patient care.