NIHR Blog

Martin Gulliford, Professor of Public Health, King’s College London, Division of Health and Social Care Research and NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospital

Unlocking the potential of EHRs for health research

Author:

Martin Gulliford, Professor of Public Health, King’s College London, Division of Health and Social Care Research and NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospital

Date: 05 September 2017

How can researchers use electronic health records to develop 'efficient' ways of generating new knowledge that will benefit patients and the public?

For several years, researchers have been harnessing the rich source of data from primary care databases to conduct observational epidemiological studies. The potential of these databases such as the Clinical Practice Research Datalink (CPRD) has been enhanced through linkage to additional data sources including hospital episode statistics, cancer registrations and death registrations among others.

We are presently conducting REDUCE, a cluster randomised trial which is using data from general practices that contribute electronic health records (EHRs) to CPRD. Supported by the NIHR Health Technology Assessment (HTA) Programme, our trial aims to test the effectiveness of electronically delivered interventions to reduce unnecessary antibiotic prescribing for respiratory infections in primary care. Excessive use of antibiotics is harmful because this facilitates the emergence of antibiotic resistant bacteria.

Using the primary care database gives us access to a very large population that can be included in the study at a low cost. In our previous study on antimicrobial stewardship, data were analysed for 603,409 patients registered at 104 practices. Studies of this size have considerable power to detect small differences of clinical relevance.

How we are using EHRs
The database provides a sampling frame comprising a listing of several hundred practices that are eligible for the study. All trial practices were recruited from CPRD. This enabled us to include practices from all parts of the UK, including England, Wales, Scotland and Northern Ireland.

Primary care EHRs are being used to develop the intervention. Intervention trial arm practices are being sent monthly-updated antibiotic prescribing reports based on analysis of EHR data. A unique strength of analysis of EHRs is that this enables us to distinguish particular prescribing indications and population sub-groups.

Primary care EHRs will also be used to evaluate trial outcomes including antibiotic prescribing rates, respiratory consultations rates and safety outcomes, such as the occurrence of pneumonia.

Conducting trials using EHRs requires collaboration across different organisations. In our present trial, we are working closely with colleagues at CPRD. We have worked with small and medium-sized enterprises in the information services sector to help us develop and deliver interventions into general practices and to conduct automated allocation.

There are a number of factors that we have had to take into consideration with the use of EHRs. Governance arrangements for EHR trials require special consideration for data protection, confidentiality and patient anonymity. This may require investigators to be ‘blind’ to the identity of practices participating in the trial.

EHRs contain records of data that are routinely collected in clinical consultations. These data inevitably differ from prospectively-recorded data from epidemiological studies. Investigators will require familiarity with the coding dictionaries, measurements methods and data structures that are employed in EHR data sources.

Conducting pragmatic clinical trials in ‘usual care settings’ is now of growing interest. These trials are sometimes referred to as ‘point-of-care’ trials, or even ‘real-world’ trials’. Tjeerd van Staa and colleagues outlined some of the difficulties facing such trials in their report of the HTA’s e-Lung study. In spite of the difficulties, some successful examples are now being reported. The Salford Lung Study, employed EHRs in an evaluation of the effectiveness of newer treatments for chronic obstructive pulmonary disease (COPD).

With the rapid development of health informatics infrastructure, and clinical and population health information systems, we can expect that use of data from EHRs in trials and intervention studies will become more routine. This will enable large trials to be conducted at lower cost, in settings that more closely resemble ‘usual care’.

Martin Gulliford is the chief investigator for 13/88/10 Electronically-delivered, multi-component interventions to reduce unnecessary antibiotic prescribing in primary care. A cluster randomised trial using electronic health records (eCRT2).

He is Professor of Public Health, King’s College London, Division of Health and Social Care Research and NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospital

 

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
  • Summary:
    Martin Gulliford writes about how researchers are using electronic health records (EHRs) to generate new knowledge to benefit patients and the public. It is the latest blog in our efficient studies series.
  • Year:
    2017
  • Author:

    Martin Gulliford, Professor of Public Health, King’s College London, Division of Health and Social Care Research and NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospital

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