Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA.
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
J Am Med Inform Assoc. 2020 Jan 1;27(1):127-135. doi: 10.1093/jamia/ocz172.
The study sought to assess the feasibility of nationwide chronic disease surveillance using data aggregated through a multisite collaboration of customers of the same electronic health record (EHR) platform across the United States.
An independent confederation of customers of the same EHR platform proposed and guided the development of a program that leverages native EHR features to allow customers to securely contribute de-identified data regarding the prevalence of asthma and rate of asthma-associated emergency department visits to a vendor-managed repository. Data were stratified by state, age, sex, race, and ethnicity. Results were qualitatively compared with national survey-based estimates.
The program accumulated information from 100 million health records from over 130 healthcare systems in the United States over its first 14 months. All states were represented, with a median coverage of 22.88% of an estimated state's population (interquartile range, 12.05%-42.24%). The mean monthly prevalence of asthma was 5.27 ± 0.11%. The rate of asthma-associated emergency department visits was 1.39 ± 0.08%. Both measures mirrored national survey-based estimates.
By organizing the program around native features of a shared EHR platform, we were able to rapidly accumulate population level measures from a sizeable cohort of health records, with representation from every state. The resulting data allowed estimates of asthma prevalence that were comparable to data from traditional epidemiologic surveys at both geographic and demographic levels.
Our initiative demonstrates the potential of intravendor customer collaboration and highlights an organizational approach that complements other data aggregation efforts seeking to achieve nationwide EHR-based chronic disease surveillance.
本研究旨在评估通过美国多个使用相同电子健康记录（EHR）平台的客户的多站点合作来汇总数据，对全国性慢性病监测的可行性。
一个独立的客户联盟提出并指导了一个计划的制定，该计划利用 EHR 的固有功能，允许客户安全地向供应商管理的存储库提供有关哮喘患病率和哮喘相关急诊就诊率的数据。数据按州、年龄、性别、种族和民族进行分层。结果与基于全国性调查的估计进行了定性比较。
该计划在其头 14 个月内从美国 130 多个医疗系统的 1 亿份健康记录中积累了信息。所有州都有代表，中位数覆盖率为估计州人口的 22.88%（四分位距，12.05%-42.24%）。哮喘的月平均患病率为 5.27 ± 0.11%。哮喘相关急诊就诊率为 1.39 ± 0.08%。这两个指标都与基于全国性调查的估计相吻合。
通过围绕共享 EHR 平台的固有功能组织该计划，我们能够从大量健康记录中快速积累人群水平的指标，并且每个州都有代表。由此产生的数据允许对哮喘患病率进行估计，这些估计与地理和人口统计学水平的传统流行病学调查数据相当。
我们的倡议展示了内部客户合作的潜力，并强调了一种组织方法，该方法补充了其他寻求实现全国性基于 EHR 的慢性病监测的聚合数据努力。
