A byproduct of the implementation of an electronic health record is the creation of a relatively large clinical database. The core value of this data is supporting the provision of care. There are other uses — secondary uses — which are important.
Perhaps the most important secondary use is assessing the quality, efficiency, and safety of care. Care patterns can be contrasted with national guidelines; a physician’s practice can be compared to that of other physicians; and the health of a population of people with a chronic disease can be assessed.
However, several organizations have begun to look at additional secondary uses of this data. Two areas show great promise.
One area is post-market surveillance of medications. The graph above (Brownstein, PLoS ONE, 2007) was developed using data from Partners HealthCare. It shows a dramatic increase in admissions due to heart attack. The arrows indicate when our physicians began to prescribe Vioxx and when they stopped prescribing Vioxx. This example raises some interesting possibilities — could we begin to monitor a medication soon after it is introduced and do a much better job of detecting problems earlier?
Another area is leveraging EHR data for clinical research. An area Partners is working on centers on genome association studies (www.i2b2.org), e.g., are there genes associated with depression treatment success? The graph above (Kohane, Internal Partners Analysis, 2008) is a bit complicated, but it shows that studies that leverage EHR data (the lowest set of lines) can cost five times less than studies that rely on manual chart extraction (the top set of lines). In addition, it appears that EHR-based studies can be done in one-tenth the time. These gains in efficiency and speed could dramatically alter clinical research.z
There is still much work that remains, e.g., developing sound methods for dealing with the often poor quality of EHR data. However, both of these examples show very compelling potential secondary uses of clinical data.
John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.