Hernandez Monique N, Voti Lydia, Feldman Jason D, Tannenbaum Stacey L, Scharber Wendy, Mackinnon Jill A, Lee David J, Huang Youjie X
J Registry Manag. 2013 Spring;40(1):40-7.
Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes.
To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement.
A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast.
A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5 percent of registry records with updated surgery information, 1 percent of records with updated radiation information, and 7 percent of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data.
Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.
医院电子病历（EMR）系统在患者数据管理方面的整合程度日益提高，特别是考虑到医疗补助与医疗照顾服务中心最近发布的政策变化。除了数据管理外，这些数据还为包括癌症在内的一系列疾病的以患者为中心的结局研究提供了证据。将电子病历患者数据与现有疾病登记系统整合，可强化确保最佳健康结局的所有关键要素。
确定提取、链接和处理医院电子病历数据与佛罗里达癌症数据系统（FCDS）的机制；评估现有登记系统治疗数据的完整性以及数据增强的潜力。
佛罗里达州卫生部、FCDS与佛罗里达州一个大型医院系统建立了合作关系，以开发医院电子病历提取和传输方法。使用国际疾病分类第九版临床修订本（ICD-9-CM）编码作为触发条件，提取2007年至2010年入院年份的记录，并将其与乳腺癌浸润性癌患者的癌症登记系统相链接。
共有11506名独特患者与总共12804个独特的乳腺肿瘤相链接。根据医院电子病历对现有登记系统治疗数据进行评估，结果显示，登记系统记录中有5%的手术信息得到更新，1%的放疗信息得到更新，7%的化疗信息得到更新。登记系统治疗信息的增强尤其受到化疗药物数据可用性的影响。
医院电子病历与癌症疾病登记系统的链接是可行的，但受到数据收集、编码和传输缺乏标准、可用数据的全面描述以及某些医院数据集被排除等问题的挑战。FCDS标准治疗数据变量高度可靠且完整，但可通过添加以患者为中心的结局研究中常用的详细化疗方案来加以增强。
