International comparisons of 'big' health record data: application to cardiovascular diseases

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Cardiovascular diseases (CVD) remain the leading cause of death in the UK and worldwide. With medical advancement in drug treatment and revascularization intervention, the acute hospital treatment phase shortens and the care for CVD has gradually shifted to primary care and community services. International comparisons can provide evidence of performance of health system in CVD care between countries, and thus facilitate learning from better performing systems. One of the near-term grand challenges is to exploit international structured coded data arising from primary and secondary care to address the gap of putting scientific evidence on prevention and treatment into clinical practice to improve population health. While the quality and comprehensiveness of UK healthcare data is exceptional in world, there are remarkably few instances of UK health records being used in international research contexts. A central bottleneck is knowing what electronic health records (EHR) sources are available for research, and their strengths and weakness. There has been no concerted effort to make such data sources 'discoverable,' shareable or accessible to the international research community. Even the most simple questions (e.g. which countries have primary care data available for research, and which of these can provide meaningful data on smoking, blood pressure and cholesterol) do not have readily accessible answers.With the support from the MRC Population Health Scientist Fellowship, in close collaboration with the Farr institute, I will expand international collaboration on linked population health records to investigate important research questions on cardiac care, and address some of the barriers in the field of health informatics. I will do this by addressing two interwoven aims: (i) Clinical research: to address research questions in the prevention and progression of cardiovascular diseases across two or more countries, which can only be tackled using electronic health record data. (ii) Informatics methods: To facilitate the discovery and documentation of contemporary EHR data sources relevant to cardiovascular disease research in countries with diverse healthcare systems by working in close collaboration with health informatics experts across the Farr Institute.OBJECTIVES (i) Clinical research objectives will be first to compare the extent to which adherence to major new guideline recommendations might be associated with reduction in a wide range of CVD in two or more countries. Second, to compare the incidence of CVD, such as heart failure in the short and long term after acute myocardial infarction between two or more countries. (ii) Informatics method objectives will be first to build an inter-disciplinary, international network of investigators and resources seeking to make EHR data sources discoverable and sharable for cardiovascular research. Second, to facilitate the creation of an international searchable meta-data catalogue of EHR data from different health care settings through the Farr Institute and the Health Informatics Network. Potential applications and benefitsBy focused on CVD, research results are expected to provide insights on effective health system and care strategies to contribute to the health and wellness of the population. The research may contribute to knowledge by firstly providing the unique understanding the quality and outcome consequences of preventive and treatment care across countries. Secondly, and tightly interwoven with the substantive clinical questions, I will be able to contribute to the knowledge of methods by making complex data sources across countries more 'discoverable', and provide the contextual and metadata information required in order to scale replicable research using these data sources. The research will contribute to our knowledge on research collaboration, study coordination and information governance for international health informatics studies.