Using EHRs to integrate research with patient care: promises and challenges: Table 1

Abstract

Clinical research is the foundation for advancing the practice of medicine. However, the lack of seamless integration between clinical research and patient care workflow impedes recruitment efficiency, escalates research costs, and hence threatens the entire clinical research enterprise. Increased use of electronic health records (EHRs) holds promise for facilitating this integration but must surmount regulatory obstacles. Among the unintended consequences of current research oversight are barriers to accessing patient information for prescreening and recruitment, coordinating scheduling of clinical and research visits, and reconciling information about clinical and research drugs. We conclude that the EHR alone cannot overcome barriers in conducting clinical trials and comparative effectiveness research. Patient privacy and human subject protection policies should be clarified at the local level to exploit optimally the full potential of EHRs, while continuing to ensure participant safety. Increased alignment of policies that regulate the clinical and research use of EHRs could help fulfill the vision of more efficiently obtaining clinical research evidence to improve human health.

A Comparison of Data Quality Assessment Checks in Six Data Sharing Networks

“…3 The resulting large-scale deployment of EHRs has increased access to patient information and the amount of data available for secondary use. 4,5 EHRs are a resource for knowledge discovery and have facilitated significant advancement in clinical practice and research. [6][7][8][9] While the potential usage of these data offers significant promise, the quality of EHR-generated data have long been called into question.…”

Utilization of the EPIC Electronic Health Record System for Clinical Trials Management at Duke University

“…Beginning the discovery phase, we understood clinical workflows previously collected for the larger clinical EPIC implementation would differ greatly from those needed for research [4]. Understanding how the research community currently performed their work was of paramount importance.…”

Challenges in Outcome Measurement: Clinical Research Perspective

“…These databases and systems often lack standard content, structure, or format across providers, facilities, and systems, introducing substantial barriers to aggregating data for larger-scale analyses. The data in these systems are often not constructed for research-related data abstraction and may be insufficient or incomplete for research purposes, making retrieval tedious, error-prone, and costly [37,38]. For example, many of these systems require significant reprogramming to create a single, detailed data matrix of variables in columns indexed by patients in rows, as is typically needed for statistical analyses.…”

“…Practical Barriers: Rethink Current Clinical Processes Practical challenges to wide-scale outcome measurement exist, but with the continuing trend toward electronic medical records and interconnected administrative systems [27,37,38], these issues are ultimately unlikely to be the limiting factor. Some recent systems have been developed and implemented using standard measures and connecting across different data sources (eg, medical records and financial databases) [8,10].…”