Key Learning Points. The History. Electronic Record Keeping for Research Databases. The Electronic Health Record (EHR) Research with EHR

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1 Electronic Record Keeping for Research Databases Ove A. Peters, DMD MS PhD Diplomate, American Board of Endodontics Chicago IL August 24, 2012 Key Learning Points The Electronic Health Record (EHR)! -! which systems are mainly in use! -! primary properties Research with EHR! -! possible approach! -! current standing and results Obstacles and directions! - case studies - future directions The History The Electronic Health Record (EHR)! -! is...a repository for patient information...supported by digital computer input Goals! -! improve quality: better data for management! -! aid in evidence-based decision making Problems! -! cost: of total clinic budget - adaptation period, faculty learning phase Atkinson et al 2002

2 The History Development! -! started in the 1960ties with PROMIS (medicine) - abandoned because of too rigid data entry structure Paperless?! -! often double structures require paper trails! -! integrating all aspect such as radiography etc. Main aspects! -! health history, treatment planning/documentation, financial transaction, scheduling Atkinson et al 2002 The History Safety! -! co-signature is needed with both faculty and students/ residents sign off on a treatment procedure, this is different from practice management software Privacy! -! HIPAA regulations would drive the restriction of student access while faculty needs to see many records Critical aspects! - should not be an electronic analog of paper forms - coding (ICD, Snodent, CDT-3) is essential Atkinson et al 2002 Are you using an electronic health record for documentation at your school? 1. Yes 2. No Reasons/ issues Future! - productivity, ease of use, IPads etc. - all with use electronic EHR paperless Expert help needed! -! it support, cost

3 Which software is used at your school? 1. AxiUm 2. General Systems 3. Quality Systems 4. Dentrix 5. Others (Salud, Softdent, Dental.com, Eaglesoft, ICE) Research Promises! -! in 2002, there was great hope that EHR may be useful for research purposes Key issue! - data entry must be controlled so that search and retrieval is facilitated; free text must be minimized Research principles! -! prospective vs retrospective data collection - hypothesis-driven approach Atkinson et al 2002 COHRI Brief history! - a Consortium for Oral Health-Related Informatics founded from Tufts Dental School after AxiUm started Needs analysis! - conduct outcome assessment - relationship between oral health & systemic diseases - use the EHR platform for various research types - develop and measure standard clinical practices - measure students clinical performance - measure accuracy of clinical treatment planning - measure accuracy and validity of educational outcomes - perform an epidemiologic analysis of diseases and treatments by patient demographics

4 COHRI: An Example Stark et al 2010 COHRI: The Repository Research Re-using clinical data for research! - in endodontics: demographic of p.a. disease - Advance computational methods for research! -! PRBNs, using a web-based network to rapidly collect data from many locations - REDCap, a research data capturing tool Re-purposing existing research data! -! Facebase repository - hypothesis-driven approach, workflow tools Schleyer et al 2012 SHRINE

5 REDCap Facebase My Experiment Have you used data from any electronic health record for research? 1. Yes 2. No

6 Why / Why not? Example 1 Location of p.a. lesions! - generate a large sample of patient using AxiUm - search corresponding patients Rx and health history Problems:! -! identification of patients - entry of health history not coded Solutions:! -! created an overlay Access database - operator work needed A Research Project What is the biggest obstacle to using a electronic health record for research? 1. Unstructured data entry/coding 2. Difficult process to write out data 3. IRB problems 4. Lack of dedicated staff/expertise 5. other

7 Data management! - extraction of data from original system often difficult - secondary manual entry as a workaround Confidentiality issues! -! retrospective analyses often need to look at individuals - second database allows for coding Expert help needed! -! code needs to be written... - IRB support Have you or do you expect to have publications in endodontics from an electronic health record? 1. Yes 2. No Where do you see the biggest opportunity for an electronic health record in endodontics? 1. Assessment of student/resident performance 2. Retrospective analyses of treatments 3. Prospective trials 4. Practice based network utilization 5. other Benefits of EHR for prospective studies! - can work but comparatively little gain - works better for large retrospective studies Teaching assessment! - easy to use and readily accessible tool - perhaps underutilized? PBRN! -! significant potential - needs more acceptance, software issues

8 Example 2 Grade distribution! - validate clinical assessment - test cases are entered into database Structure! -! simple query for the codes in a CE - comparison across faculty Problems! -! scale is perhaps too narrow - what do the data mean? Student Gradings Is the implementation/adaptation of an electronic health record a priority at you school? 1. Yes 2. No Anything to add? Inevitable What about TDO?

9 References Atkinson JC et al Electronic health records for dental school clinics: more than paperless systems. J Dent Educ 2002, 66: Stark PC et al Consortium of oral health-related informatics: improving dental research, education and treatment. J Dent Educ 2010, 74: Schleyer TK et al From information technology to informatics: the information revolution in dental education J Dent Educ 2012, 76: