Generalizability of Indicators from the New York City Macroscope Electronic Health Record Surveillance System to Systems Based on Other EHR Platforms.
Generalizability of Indicators from the New York City Macroscope Electronic Health Record Surveillance System to Systems Based on Other EHR Platforms.
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DOI：
10.5334/egems.247
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发表时间：
2017-12-07
期刊：
影响因子：
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通讯作者：
Perlman SE
中科院分区：
文献类型：
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作者：
McVeigh KH;Lurie-Moroni E;Chan PY;Newton-Dame R;Schreibstein L;Tatem KS;Romo ML;Thorpe LE;Perlman SE
纽约市（NYC）宏观监测系统是一个电子健康记录（EHR）监测系统，基于Hub人口健康系统的初级保健记录分布式网络。在eGEMS上发表的前三部分系列文章中，我们报告了纽约市宏观健康指标的有效性;然而，关于它们对其他EHR监测系统的可推广性仍然存在问题。我们从2013-14年纽约市健康和营养检查调查的142名参与者的20多个EHR软件系统中提取了初级保健图表数据，这些参与者没有向纽约市宏观调查提供数据。然后，我们计算指标的敏感性和特异性，比较从EHR中提取的数据与调查数据。肥胖和糖尿病指标具有中度至高度敏感性（0.81-0.96）和高度特异性（0.94-0.98）。吸烟状况和高血压指标具有中等敏感性（0.78-0.90）和中度至高度特异性（0.88-0.98）;当样本仅限于证明第1阶段有意义使用的提供者的记录时，敏感性有所提高。高血压指标具有中等灵敏度（≥0.72）和低特异性（≤0.59），当限制为第1阶段有意义使用时变化极小。NYC Macroscope中使用的肥胖和糖尿病指标可以适用于其他EHR监测系统，只需最小的验证。然而，建议对吸烟状况和高血压指标进行额外验证，并需要进一步开发高脂血症指标。我们的研究结果表明，许多EHR为基础的监测指标开发和验证的纽约宏观可推广用于其他EHR监测系统。
The New York City (NYC) Macroscope is an electronic health record (EHR) surveillance system based on a distributed network of primary care records from the Hub Population Health System. In a previous 3-part series published in eGEMS, we reported the validity of health indicators from the NYC Macroscope; however, questions remained regarding their generalizability to other EHR surveillance systems. We abstracted primary care chart data from more than 20 EHR software systems for 142 participants of the 2013–14 NYC Health and Nutrition Examination Survey who did not contribute data to the NYC Macroscope. We then computed the sensitivity and specificity for indicators, comparing data abstracted from EHRs with survey data. Obesity and diabetes indicators had moderate to high sensitivity (0.81–0.96) and high specificity (0.94–0.98). Smoking status and hypertension indicators had moderate sensitivity (0.78–0.90) and moderate to high specificity (0.88–0.98); sensitivity improved when the sample was restricted to records from providers who attested to Stage 1 Meaningful Use. Hyperlipidemia indicators had moderate sensitivity (≥0.72) and low specificity (≤0.59), with minimal changes when restricting to Stage 1 Meaningful Use. Indicators for obesity and diabetes used in the NYC Macroscope can be adapted to other EHR surveillance systems with minimal validation. However, additional validation of smoking status and hypertension indicators is recommended and further development of hyperlipidemia indicators is needed. Our findings suggest that many of the EHR-based surveillance indicators developed and validated for the NYC Macroscope are generalizable for use in other EHR surveillance systems.