Importance of Health Information Technology, Electronic Health Records, and Continuously Aggregating Data to Comparative Effectiveness Research and Learning Health Care

Abstract

Rapidly accumulating clinical information can support cancer care and discovery. Future success depends on information management, access, use, and reuse. Electronic health records (EHRs) are highlighted as a critical component of evidence development and implementation, but to fully harness the potential of EHRs, they need to be more than electronic renderings of the traditional paper medical chart. Clinical informatics and structured accessible secure data captured through EHR systems provide mechanisms through which EHRs can facilitate comparative effectiveness research (CER). Use of large linked administrative databases to answer comparative questions is an early version of informatics-enabled CER familiar to oncologists. An updated version of informatics-enabled CER relies on EHR-derived structured data linked with supplemental information to provide patient-level information that can be aggregated and analyzed to support hypothesis generation, comparative assessment, and personalized care. As implementation of EHRs continues to expand, electronic databases containing information collected via EHRs will continuously aggregate; aggregating data enhanced with real-time analytics can provide point-of-care evidence to oncologists, tailored to patient-level characteristics. The system learns when clinical care informs research, and insights derived from research are reinvested in care. Challenges must be overcome, including interoperability, standardization, access, and development of real-time analytics.

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…In addition, aggregation of EHR data across practices could enable more efficient hypothesis testing and comparative effectiveness research in order to improve patient care, especially in combination with real-time analytics. 138 The hope is that, eventually, de-identified EHR data will become a source of clinical data not currently available from either surveys or claims. However, much work remains to ensure that information is consistently collected in a useful format for analysis.…”

Knowledge driven lean in healthcare: a necessity

“…HIT is seen as a tool that has the potential of improving the healthcare -and health -of our nation. Improvements in quality and efficiency of care (cornerstones of lean) are seen as inevitable with the implementation of HIT like "pharmacy systems, research and registry databases, practice management systems such as billing and scheduling, and patient devices" [Miriovsky et al, (2012), p.1]. It is true that information management is an integral part of care delivery and that technology may be able to help improve this component of the healthcare process.…”

“…As with many organisational change initiatives, there is usually a loss of clinical efficiency after the EHRs are put to use, which may or may not level out (Miriovsky et al, 2012). While it is often projected that increases in efficiency will come about over time as providers become familiar with the EHR system (though the lack of long-term evaluations make this future uncertain), some studies have found that physicians spend more time on computer-related activities and thus spend less time on face to face interactions with the patient.…”

“…Many researchers are enthusiastic over the idea that EHRs will provide a way to aggregate patient level data into health information exchanges that allow the data to be analysed for a variety of purposes: to improve care delivery, streamline administrative operations, perform comparativeeffectiveness research (CER), etc. Miriovsky et al (2012) describe the ways in which informatics-enabled CER could be used to deepen understanding of cancer and other disease care. They foresee health information exchanges compiled of large amounts of patient data that allow rapid-learning systems of care: decreasing the period of time needed for discovery and interventions of some cancers, constantly updating disease databases with new information to better personalise care, etc.…”

“…Appointments could be scheduled regularly due to reminders and investigating aggregated patient data could result in important health discoveries (Miriovsky et al, 2012). EHRs seem like an ideal way to combat healthcare operational waste while increasing the efficiency and quality of patient care; however, there are several areas of concern surrounding EHR use within a lean system.…”