Considerations for Integration of Perioperative Electronic Health Records Across Institutions for Research and Quality Improvement: The Approach Taken by the Multicenter Perioperative Outcomes Group.
Considerations for Integration of Perioperative Electronic Health Records Across Institutions for Research and Quality Improvement: The Approach Taken by the Multicenter Perioperative Outcomes Group.
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DOI：
10.1213/ane.0000000000004489
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发表时间：
2020-05
影响因子：
5.7
通讯作者：
Mathis MR
中科院分区：
文献类型：
--
作者：
Colquhoun DA;Shanks AM;Kapeles SR;Shah N;Saager L;Vaughn MT;Buehler K;Burns ML;Tremper KK;Freundlich RE;Aziz M;Kheterpal S;Mathis MR
在美国，电子健康记录（EHR）的使用已成为围手术期护理的常规部分。EHR数据的二次使用包括研究，质量和教育计划。二次使用的基础是一个框架，以确保源数据的保真度，透明度和完整性。在制定这一框架时，必须考虑到相互竞争的优先事项，即使用哪些数据源以及如何组织数据并将其纳入可用的格式。在收集来自美国和欧洲不同机构的围手术期数据时，多中心围手术期结局组（MPOG）已经开发出支持这种框架的方法。这篇特殊的文章概述了MPOG如何处理数据结构，验证和可访问性的考虑，以支持围手术期EHR的多中心整合。在这个多中心实践注册中，MPOG开发了从围手术期EHR中提取数据的流程;将数据转换为标准化格式;并验证，去识别和将数据传输到安全的中央协调中心数据库。参与机构可以访问由质量和研究委员会管理的中央数据库，以告知临床实践并为科学和临床社区做出贡献。通过严格和标准化的方法来确保数据的完整性，MPOG使数据能够用于质量改进和推进科学知识。截至2019年3月，我们与46家医院的合作已经积累了1070万份麻醉记录，以及来自不同供应商的相关围手术期EHR数据。在MPOG的帮助下，每个研究中心都可以访问本地存储库，其中包含所有研究中心特定的围手术期数据，这些数据与源EHR不同，可随时用于本地研究、质量和教育计划。通过委员会批准程序，参与研究中心的研究者可以额外访问类似计划的多中心数据。从这项工作中产生了我们小组优先考虑的4个因素，以提高数据质量：（1）在协调中心转移之前，数据应在当地水平可用;（2）在使用之前，数据应根据标准化指标进行严格验证;（3）数据应被整理成易于访问的可计算表型;（4）数据的收集应该同时用于研究和质量改进，因为这些互补的目标增强了每一项奋进的力量。
Use of the electronic health record (EHR) has become a routine part of perioperative care in the United States. Secondary use of EHR data includes research, quality, and educational initiatives. Fundamental to secondary use is a framework to ensure fidelity, transparency, and completeness of the source data. In developing this framework, competing priorities must be considered as to which data sources are used and how data are organized and incorporated into a useable format. In assembling perioperative data from diverse institutions across the United States and Europe, the Multicenter Perioperative Outcomes Group (MPOG) has developed methods to support such a framework. This special article outlines how MPOG has approached considerations of data structure, validation, and accessibility to support multicenter integration of perioperative EHRs. In this multicenter practice registry, MPOG has developed processes to extract data from the perioperative EHR; transform data into a standardized format; and validate, deidentify, and transfer data to a secure central Coordinating Center database. Participating institutions may obtain access to this central database, governed by quality and research committees, to inform clinical practice and contribute to the scientific and clinical communities. Through a rigorous and standardized approach to ensure data integrity, MPOG enables data to be usable for quality improvement and advancing scientific knowledge. As of March 2019, our collaboration of 46 hospitals has accrued 10.7 million anesthesia records with associated perioperative EHR data across heterogeneous vendors. Facilitated by MPOG, each site retains access to a local repository containing all site-specific perioperative data, distinct from source EHRs and readily available for local research, quality, and educational initiatives. Through committee approval processes, investigators at participating sites may additionally access multicenter data for similar initiatives. Emerging from this work are 4 considerations that our group has prioritized to improve data quality: (1) data should be available at the local level before Coordinating Center transfer; (2) data should be rigorously validated against standardized metrics before use; (3) data should be curated into computable phenotypes that are easily accessible; and (4) data should be collected for both research and quality improvement purposes because these complementary goals bolster the strength of each endeavor.