Exploiting time in electronic health record correlations
Exploiting time in electronic health record correlations
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DOI：
10.1136/amiajnl-2011-000463
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发表时间：
2011-12-01
影响因子：
6.4
通讯作者：
Perotte, Adler
中科院分区：
文献类型：
--
作者：
Hripcsak, George;Albers, David J.;Perotte, Adler
目的 证明大型异构临床数据库可以揭示临床关联中的精细时间模式；说明几种类型的关联；材料和方法 7 个临床实验室值和 30 个临床概念之间的滞后线性相关性是从 22 年、300 万患者的电子健康记录数据库中提取的居民签核记录中提取的。对时间点进行插值，并对患者进行标准化，以减少患者间的影响。结果 该方法揭示了几种类型与详细时间模式的关联。定义关联包括“低钾血症”之前的低血钾。药物螺内酯之前的低钾和螺内酯之后的高钾分别例证了有意关联和生理关联。违反直觉的结果，例如疾病似乎跟随其影响的事实可能是由于医疗保健的工作流程，其中临床发现先于临床医生对疾病的诊断，尽管疾病实际上先于发现。通过插值时间点充分利用时间产生较少噪音的结果。讨论电子健康记录不是患者状态的直接反映，而是医疗保健过程和记录过程的反映。通过适当的技术和理解，并适当结合时间，可以从大型临床数据库中得出可解释的关联。结论大型、异构的临床数据库可以揭示临床关联，时间是一个重要特征，必须小心解释结果。
Objective To demonstrate that a large, heterogeneous clinical database can reveal fine temporal patterns in clinical associations; to illustrate several types of associations; and to ascertain the value of exploiting time.Materials and methods Lagged linear correlation was calculated between seven clinical laboratory values and 30 clinical concepts extracted from resident signout notes from a 22-year, 3-million-patient database of electronic health records. Time points were interpolated, and patients were normalized to reduce inter-patient effects.Results The method revealed several types of associations with detailed temporal patterns. Definitional associations included low blood potassium preceding 'hypokalemia.' Low potassium preceding the drug spironolactone with high potassium following spironolactone exemplified intentional and physiologic associations, respectively. Counterintuitive results such as the fact that diseases appeared to follow their effects may be due to the workflow of healthcare, in which clinical findings precede the clinician's diagnosis of a disease even though the disease actually preceded the findings. Fully exploiting time by interpolating time points produced less noisy results.Discussion Electronic health records are not direct reflections of the patient state, but rather reflections of the healthcare process and the recording process. With proper techniques and understanding, and with proper incorporation of time, interpretable associations can be derived from a large clinical database.Conclusion A large, heterogeneous clinical database can reveal clinical associations, time is an important feature, and care must be taken to interpret the results.