Dataset Information

Secondary use of electronic medical records for clinical research: Challenges and Opportunities.

ABSTRACT: With increasingly ubiquitous electronic medical record (EMR) implementation accelerated by the adoption of the HITECH Act, there is much interest in the secondary use of collected data to improve outcomes and promote personalized medicine. A plethora of research has emerged using EMRs to investigate clinical research questions and assess variations in both treatments and outcomes. However, whether because of genuine complexities of modeling disease physiology or because of practical problems regarding data capture, data accuracy, and data completeness, the state of current EMR research is challenging and gives rise to concerns regarding study accuracy and reproducibility. This work explores challenges in how different experimental design decisions can influence results using a specific example of breast cancer patients undergoing excision and reconstruction surgeries from EMRs in an academic hospital and the Veterans Health Administration (VHA) We discuss emerging strategies that will mitigate these limitations, including data sharing, application of natural language processing, and improved EMR user design.

SUBMITTER: Yim WW

PROVIDER: S-EPMC5933881 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Secondary use of electronic medical records for clinical research: Challenges and Opportunities.

Yim Wen-Wai WW Wheeler Amanda J AJ Curtin Catherine C Wagner Todd H TH Hernandez-Boussard Tina T

Convergent science physical oncology 20180212 1

With increasingly ubiquitous electronic medical record (EMR) implementation accelerated by the adoption of the HITECH Act, there is much interest in the secondary use of collected data to improve outcomes and promote personalized medicine. A plethora of research has emerged using EMRs to investigate clinical research questions and assess variations in both treatments and outcomes. However, whether because of genuine complexities of modeling disease physiology or because of practical problems reg ...[more]

PMID: 29732166

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Project description:BackgroundIn South Korea, most graduated medical students undertake a 1-year internship before beginning residency and specialization. Interns usually work in a tertiary hospital and rotate between different, randomly assigned departments to be exposed to different medical specialties. Their jobs are mostly simple and repetitive but are still essential for the patient care process. However, owing to the lack of experience and overwhelming workload, interns at tertiary hospitals in South Korea are usually inefficient, often delaying the entire clinical process. Health care providers have widely adopted mobile electronic medical records (mEMRs) as they have been shown to improve workflow efficiency.ObjectiveThis study investigates the association between the frequency of mEMR usage and the clinical task completion interval time among interns in a tertiary hospital.MethodsThis mixed methods study was conducted at the Samsung Medical Center, Seoul, South Korea. Interns who worked at the Samsung Medical Center from March 2018 to February 2019 were included. The hospital electronic medical record (EMR) system known as DARWIN (Data Analysis and Research Window for Integrated kNowledge) was launched with PC and mobile. Both versions are actively used in hospitals by personnel in various positions. We collected the log data from the mEMR server and the intern clinical task time-series data from the EMR server. Interns can manage the process of identifying patients, assigning the clinical task, finishing the requested clinical intern tasks, etc, through the use of the mEMR system. We compared the clinical task completion interval among 4 groups of interns divided by the mEMR frequency quantile. Then, System Usability Score (SUS) questionnaires and semistructured interviews were conducted.ResultsThe regular mEMR users were defined as those who logged in more than once a day on average and used the mEMR until the level after login. Among a total of 87 interns, 84 used the mEMR to verify the requested clinical tasks. The most frequently used item was "Intern task list." Analysis of the 4 intern groups revealed an inverse relationship between the median time of the task completion interval and the frequency of mEMR use. Correlation analysis showed that the intern task completion time interval had a significant inverse relationship with the individual frequency of mEMR usage (coefficient=-0.27; 95% CI -0.46 to -0.04; P=.02). In the additional survey, the mean SUS value was 81.67, which supported the results of the data analysis.ConclusionsOur findings suggest that frequent mEMR use is associated with improved work efficiency in hospital interns with good usability of the mEMR. Such finding supports the idea that the use of mEMR improves the effectiveness and workflow efficiency of interns working in hospitals and, more generally, in the context of health care.

Project description:The objective was to compare case ascertainment, agreement, validity, and missing values for clinical research data obtained, processed, and linked electronically from electronic health records (EHR) compared to "manual" data processing and record abstraction in a cohort of out-of-hospital trauma patients.? This was a secondary analysis of two sets of data collected for a prospective, population-based, out-of-hospital trauma cohort evaluated by 10 emergency medical services (EMS) agencies transporting to 16 hospitals, from January 1, 2006, through October 2, 2007. Eighteen clinical, operational, procedural, and outcome variables were collected and processed separately and independently using two parallel data processing strategies by personnel blinded to patients in the other group. The electronic approach included EHR data exports from EMS agencies, reformatting, and probabilistic linkage to outcomes from local trauma registries and state discharge databases. The manual data processing approach included chart matching, data abstraction, and data entry by a trained abstractor. Descriptive statistics, measures of agreement, and validity were used to compare the two approaches to data processing.? During the 21-month period, 418 patients underwent both data processing methods and formed the primary cohort. Agreement was good to excellent (kappa = 0.76 to 0.97; intraclass correlation coefficient [ICC] = 0.49 to 0.97), with exact agreement in 67% to 99% of cases and a median difference of zero for all continuous and ordinal variables. The proportions of missing out-of-hospital values were similar between the two approaches, although electronic processing generated more missing outcomes (87 of 418, 21%, 95% confidence interval [CI] = 17% to 25%) than the manual approach (11 of 418, 3%, 95% CI = 1% to 5%). Case ascertainment of eligible injured patients was greater using electronic methods (n = 3,008) compared to manual methods (n = 629).? In this sample of out-of-hospital trauma patients, an all-electronic data processing strategy identified more patients and generated values with good agreement and validity compared to traditional data collection and processing methods.

Project description:BackgroundCall detail records (CDRs) are collected by mobile network operators in the course of providing their service. CDRs are increasingly being used in research along with other forms of big data and represent an emerging data type with potential for public good. Many jurisdictions have infrastructures for health data research that could benefit from the integration of CDRs with health data.ObjectiveThe objective of this study was to review how CDRs have been used in health research and to identify challenges and potential opportunities for their wider use in conjunction with health data.MethodsA literature review was conducted using structured search terms making use of major search engines. Initially, 4066 items were identified. Following screening, 46 full text articles were included in the qualitative synthesis. Information extracted included research topic area, population of study, datasets used, information governance and ethical considerations, study findings, and data limitations.ResultsThe majority of published studies were focused on low-income and middle-income countries. Making use of the location element in CDRs, studies often modeled the transmission of infectious diseases or estimated population movement following natural disasters with a view to implementing interventions. CDRs were used in anonymized or aggregated form, and the process of gaining regulatory approvals varied with data provider and by jurisdiction. None included public views on the use of CDRs in health research.ConclusionsDespite various challenges and limitations, anonymized mobile phone CDRs have been used successfully in health research. The use of aggregated data is a safeguard but also a further limitation. Greater opportunities could be gained if validated anonymized CDRs were integrated with routine health records at an individual level, provided that permissions and safeguards could be put in place. Further work is needed, including gaining public views, to develop an ethically founded framework for the use of CDRs in health research.

Dataset Information

Secondary use of electronic medical records for clinical research: Challenges and Opportunities.

Publications

Secondary use of electronic medical records for clinical research: Challenges and Opportunities.

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