Center for Outcomes Research and Education, Providence Health & Services, Portland, OR 97213, USA.
Med Care. 2013 Aug;51(8 Suppl 3):S80-6. doi: 10.1097/MLR.0b013e31829b1d48.
To document the strengths and challenges of using electronic health records (EHRs) for comparative effectiveness research (CER).
A replicated case study of comparative effectiveness in hypertension treatment was conducted across 4 health systems, with instructions to extract data and document problems encountered using a specified list of required data elements. Researchers at each health system documented successes and challenges, and suggested solutions for addressing challenges.
Data challenges fell into 5 categories: missing data, erroneous data, uninterpretable data, inconsistencies among providers and over time, and data stored in noncoded text notes. Suggested strategies to address these issues include data validation steps, use of surrogate markers, natural language processing, and statistical techniques.
A number of EHR issues can hamper the extraction of valid data for cross-health system comparative effectiveness studies. Our case example cautions against a blind reliance on EHR data as a single definitive data source. Nevertheless, EHR data are superior to administrative or claims data alone, and are cheaper and timelier than clinical trials or manual chart reviews. All 4 participating health systems are pursuing pathways to more effectively use EHR data for CER.A partnership between clinicians, researchers, and information technology specialists is encouraged as a way to capitalize on the wealth of information contained in the EHR. Future developments in both technology and care delivery hold promise for improvement in the ability to use EHR data for CER.
记录使用电子健康记录（EHR）进行比较疗效研究（CER）的优势和挑战。
在 4 个医疗系统中进行了高血压治疗比较疗效的复制案例研究，并要求使用指定的必需数据元素列表提取数据并记录遇到的问题。每个医疗系统的研究人员记录了成功和挑战，并提出了解决挑战的建议。
数据挑战分为 5 类：缺失数据、错误数据、无法解释的数据、提供者之间和随时间的不一致，以及存储在非编码文本注释中的数据。解决这些问题的建议策略包括数据验证步骤、使用替代标记物、自然语言处理和统计技术。
许多 EHR 问题可能会阻碍跨医疗系统进行比较疗效研究时有效数据的提取。我们的案例警告不要盲目依赖 EHR 数据作为单一的确定数据源。尽管如此，EHR 数据优于行政或索赔数据，并且比临床试验或手动图表审查更便宜、更及时。所有 4 个参与的医疗系统都在寻求更有效地将 EHR 数据用于 CER 的途径。鼓励临床医生、研究人员和信息技术专家之间建立合作伙伴关系，以利用 EHR 中包含的丰富信息。技术和医疗服务提供方面的未来发展有望提高使用 EHR 数据进行 CER 的能力。
