Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
J Am Med Inform Assoc. 2020 Dec 9;27(12):1977-1986. doi: 10.1093/jamia/ocaa186.
Disease surveillance systems are expanding using electronic health records (EHRs). However, there are many challenges in this regard. In the present study, the solutions and challenges of implementing EHR-based disease surveillance systems (EHR-DS) have been reviewed.
We searched the related keywords in ProQuest, PubMed, Web of Science, Cochrane Library, Embase, and Scopus. Then, we assessed and selected articles using the inclusion and exclusion criteria and, finally, classified the identified solutions and challenges.
Finally, 50 studies were included, and 52 unique solutions and 47 challenges were organized into 6 main themes (policy and regulatory, technical, management, standardization, financial, and data quality). The results indicate that due to the multifaceted nature of the challenges, the implementation of EHR-DS is not low cost and easy to implement and requires a variety of interventions. On the one hand, the most common challenges include the need to invest significant time and resources; the poor data quality in EHRs; difficulty in analyzing, cleaning, and accessing unstructured data; data privacy and security; and the lack of interoperability standards. On the other hand, the most common solutions are the use of natural language processing and machine learning algorithms for unstructured data; the use of appropriate technical solutions for data retrieval, extraction, identification, and visualization; the collaboration of health and clinical departments to access data; standardizing EHR content for public health; and using a unique health identifier for individuals.
EHR systems have an important role in modernizing disease surveillance systems. However, there are many problems and challenges facing the development and implementation of EHR-DS that need to be appropriately addressed.
疾病监测系统正在利用电子健康记录（EHR）进行扩展。然而，在这方面存在许多挑战。本研究回顾了基于 EHR 的疾病监测系统（EHR-DS）实施的解决方案和挑战。
我们在 ProQuest、PubMed、Web of Science、Cochrane Library、Embase 和 Scopus 中搜索了相关的关键词。然后，我们使用纳入和排除标准评估和选择文章，并最终对确定的解决方案和挑战进行分类。
最终纳入了 50 项研究，组织了 52 个独特的解决方案和 47 个挑战，分为 6 个主要主题（政策和监管、技术、管理、标准化、财务和数据质量）。结果表明，由于挑战的多面性，EHR-DS 的实施并非低成本且易于实施，需要各种干预措施。一方面，最常见的挑战包括需要投入大量时间和资源；EHR 中的数据质量差；难以分析、清理和访问非结构化数据；数据隐私和安全；以及缺乏互操作性标准。另一方面，最常见的解决方案是使用自然语言处理和机器学习算法处理非结构化数据；使用适当的技术解决方案检索、提取、识别和可视化数据；卫生和临床部门合作访问数据；标准化 EHR 内容以用于公共卫生；并为个人使用唯一的健康标识符。
EHR 系统在疾病监测系统现代化方面发挥着重要作用。然而，EHR-DS 的发展和实施面临着许多问题和挑战，需要得到适当的解决。
