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Yearb Med Inform 1995; 04(01): 98-102
DOI: 10.1055/s-0038-1638024
DOI: 10.1055/s-0038-1638024
Review Paper
Electronic Patient Records and Clinical Research
Further Information
Abstract:
The digitalization of patient records promises clinicians researchers, health administrators, and politicians new tools to transform data into information, information into knowledge, and perhaps even knowledge into wisdom. This paper will review the status of clinical databases that can be derived from electronic patient records, discuss how databases derived from routine clinical care are being used, and outline the pitfalls and limitations of using electronic patient records for clinical research.
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References
- 1 Bakker AR. The development of an integrated and co-operative hospital information system. Med Inf 1984; 9: 135-42.
- 2 Barbash GI, Safran C, Ransil BJ, Pollacd MA, Pasternak PC. Need for better so verity indexes of acute myocardia infarction under diagnosis-related group Am J Cardiol. 1987; 59: 1052-8.
- 3 Barnett GO. Computer-stored ambulatory record (COSTAR). NCHSR Research Digest 1976. D HEW publication HRA 76-3145
- 4 Beckley RF, Bleich HL. Paper Chase: a computer-based reprint storage and retrieval system. Comp Biomed Res 1977; 10: 423-30.
- 5 Bleich HL, Beckley RF, Horowitz G. et al. Clinical computing in a teaching hospital. N Engl J Med 1985; 312: 756-64.
- 6 Bleich HL, Safran C, Slack WV. Departmental and laboratory computing in two hospitals. MD Comput 1989; 6: 149-55.
- 7 Campbell JR, Civner N, Seelig CB. et al. Computerized medical records and clinic function. MD Comput 1989; 6: 282-7.
- 8 Chute CG. Clinical data retrieval and analysis: I’ve seen a case like that before. Ann New York A cad Sc 1992; 670: 133-40.
- 9 Degoulet P, Chatellier G, Devries C, Lavril M, Menard J. Computer-assisted techniques for evaluation and treatment of hypertensive patients. Am J Hypertension 1990; 3: 156-63.
- 10 Degoulet P, Menard J, Berger C, Plouin PF, Devries C, Hirell JC. Hypertension management: the computer as a participant. AmJ Med 1980; 68: 560-7.
- 11 Demlo LK, Campbell PM, Brown SS. Reliability of information abstracted from patients’ records. Med Care 1978; 16: 995-1005.
- 12 Feinleib M. Data bases, data banks and data dredging: the agony and the ecstasy. J Chron Dis 1984; 37: 783-90.
- 13 Fischer KF, Lees JA, Newman JH. Hypoglycemia in hospitalized patients: causes and outcomes. N Engl J Med 1986; 315: 1245-50.
- 14 Fries JF. ARAMIS Second Progress Report. In: American Rheumatism Association Medical Information System, Palo Alto, CA 1978
- 15 Fries JF. Time-oriented patient records and a computer-databank. JAMA 1972; 222: 1536
- 16 Gremy F. Informatics and medical methodology: random reflections about clinical data bases. Med Inform 1982; 7: 85-91.
- 17 Grossman JH. An ambulatory medical record system for patient care and health care management. Methods Inf Med (Suppl) 1972; 6: 375-82.
- 18 Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 1992; 152: 125-30.
- 19 Hlatky MA, Lee KL, Harrell FE. et al. Tying clinical research to patient care by use of an observational database. Stat Med 1984; 3: 375-87.
- 20 Horowitz GL, Bleich HL. PaperChase: a computer program to search the medical literature. N Engl J Med 1981; 305: 924-30.
- 21 Horowitz GL, Jackson JD, Bleich HL. PaperChase: self-service bibliographic retrieval. JAMA 1983; 250: 2494-99.
- 22 Iezzoni LI. ed. Risk Adjustment for Measuring Health Care Outcomes . Ann Arbor, MI: Health Administration Press; 1994
- 23 Klein LA, Compton CC. A 51-year-old woman with microscopic hematuria and an osteolytic lesion of the spine. N Engl J Med 1986; 314: 500-9.
- 24 Kurland LT, Molgaard CA. The patient record in epidemiology. Sci Am 1981; 245: 54-63.
- 25 Lee TH, Goldman L. Development and analysis of observational data bases. J Am Coli Cardiol 1989; 14: 44A-7A.
- 26 Levkoff SE, Safran C, Cleary PD, Gallop J, Phillips RS. Identification of elderly patients at risk for delirium. J Am Geriatr Soc 1988; 36: 1099-104.
- 27 Mantel N. Cautions on the use of medical databases. Stat Med 1983; 2: 355-62.
- 28 McDonald CJ, Hui SL. The analysis of humongous databases: problems and promises. Stat Med 1991; 10: 511-20.
- 29 McDonald CJ, Blevins L, Tierney WM, Martin DK. The Regenstrief medical records. MD Comput 1988; 5: 34-47.
- 30 McDonald CJ, Murray R, Jeris D. et al. A computer-basedrecord and clinical monitoring system for ambulatory care. Am J Public Health 1977; 67: 240-5.
- 31 Phillips RS, Safran C, Cleary PD, Delbanco TL. Predicting emergency re-admissions for patients discharged from the medical service of a teaching hospital. J Gen Intern Med 1987; 2: 400-5.
- 32 Pryor DB, Califf RM, Harrell FE. et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985; 23: 623-47.
- 33 Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system. J Med Syst 1983; 7: 87-102.
- 34 Pryor TA. The HELP medical record system. MD Comput 1989; 5: 22-33.
- 35 Rector AL, Nowlan WA, Kay S. Foundation for an electronic medical record. Methods Inf Med 1991; 30: 179-86.
- 36 Rosati RA, McNeer JF, Starmer CF, Mittler BS, Morris Jr JJ, Wallace AG. A new information system for medical practice. Arch Intern Med 1975; 135: 1017-24.
- 37 Rosati RA. Tying the output of clinical research to patient care. Proc Annu Meet Med Sect Am Counc Life Insur 1976; 1: 47-60.
- 38 Safran C, Bleich HL, Slack WV. Role of computing in patient care in two hospi tals. MD Comput 1989; 6: 141-8.
- 39 Safran C, Porter D, Lightfoot J. et. al ClinQuery: a system for onlirie searching of data in a teaching hospital. Ann Intern Med 1989; 111: 751-6.
- 40 Safran C, Porter D, Slack WV, Bleich HL. Diagnosis-related groups: a critical assessment of the provision for comorbidity. Med Care 1987; 25: 1011-4.
- 41 Safran C, Porter D. New uses of the large clinical data base at the Beth Israel Hospital: on-line searching by clinicians. In: Proceedings of the 10th Annual Symposium on Computer Applications in Medical Care. . Washington DC: 1986: 114-9.
- 42 Safran C, Rind D, Bakker AR, Citroen M, Slack V, Bleich HL. Protection of confidentiality in the computer-based patient record. MD Comput. 1995. (in press)
- 43 Safran C, Sobel E, Lightfoot J, Porter D. A computer program for interactive searches of a medical data base. In: Salamon R, Blum B, Jorgenson M. eds. MEDINFO 86 Proceedings of the fifth world conference on medical informatics. Amsterdam: Elsevier Science Publishers; 1986: 545-9.
- 44 Safran C. Using routinely collected data for clinical research. Stat Med 1991; 10: 559-64.
- 45 Sands DZ, Safran C, Slack WV, Bleich HL. Use of electronic mail in a teaching hospital. Proc Annu Symp Comput. Appl Med Care 1993: 306-10.
- 46 Scherrer JR, Baud R, Brisebarre EMessmer, Assimacopoulos A. A hospital information system in continuous operation and expansion: concepts, tools and migration. In: Othner HF. ed. Proceedings of the 10th Annual Symposium on Computer Applications in Medical Care. Washington DC: 1986: 120-32.
- 47 Scherrer JR, Baud RH, Hochstrasser D, Ratib R. DIOGENE: an integrated hospital information system. MD Compu 1990; 7: 81-9.
- 48 Stead WW, Hammond WE. Computerized medical records: a new resource for clinical decision making. J Med Syst 1983; 7: 213-20.
- 49 Tierney WM, Martin DK, Greenlee MC. et al. The prognosis of hyponatremia at hospital admission. J Gen Intern Med 1986; 1: 380-5.
- 50 Tierney WM, McDonald CJ. Practice databases and their uses in clinical research. Stat Med 1991; 10: 541-59.
- 51 Vander Lei J, Duisterhout JS, Westerhof HP. et al. The introduction of computer-based patient records in the Netherlands. Ann Intern Med 1993; 119: 1036-41.
- 52 Vander Lei J, Musen MA, van der Does E, Man in’t Veld AJ, van Bemmel JH. Comparison of computer-aided and human review of general practitioners’ management of hypertension. Lancet 1991; 338: 1504-8.
- 53 Warner HR, Olmsted CM, Rutherford BD. HELP: a program for medical decision-making. Com put Biomed Res 1972; 5: 65-74.
- 54 Weed LL. Medical records that guide and teach. N Engl JMed 1968; 278: 593-600.
- 55 Whiting-O’Keefe QE, Simborg DW, Epstein WV, Warger AW. A computerized summary medical record system can provide more information than the standard medical record. JAMA 1985; 254: 1185-92.
- 56 Wyatt J. Clinical data systems, part 1: data and medical records. Lancet 1993; 344: 1543-7.
- 57 Wyatt J. Clinical data systems, part 2: components and techniques. Lancet 1993; 344: 1609-14.
- 58 Wyatt J. Clinical data systems, part 3: data and medical records. Lancet 1993; 344: 1682-8.
- 59 Zwetsloot-Schonk JHM, Snitker p Vandenbroucke JP, Bakker AR. Using hospital information systems for clinical epidemiological research. Med Inform 1989; 14: 53-62.
Address of the author:
C. Safran
Center for Clinical Computing
Beth Israel Hospital
Harvard Medical School
350 Longwood Avenue
Boston, MA, 02115
USA
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References
- 1 Bakker AR. The development of an integrated and co-operative hospital information system. Med Inf 1984; 9: 135-42.
- 2 Barbash GI, Safran C, Ransil BJ, Pollacd MA, Pasternak PC. Need for better so verity indexes of acute myocardia infarction under diagnosis-related group Am J Cardiol. 1987; 59: 1052-8.
- 3 Barnett GO. Computer-stored ambulatory record (COSTAR). NCHSR Research Digest 1976. D HEW publication HRA 76-3145
- 4 Beckley RF, Bleich HL. Paper Chase: a computer-based reprint storage and retrieval system. Comp Biomed Res 1977; 10: 423-30.
- 5 Bleich HL, Beckley RF, Horowitz G. et al. Clinical computing in a teaching hospital. N Engl J Med 1985; 312: 756-64.
- 6 Bleich HL, Safran C, Slack WV. Departmental and laboratory computing in two hospitals. MD Comput 1989; 6: 149-55.
- 7 Campbell JR, Civner N, Seelig CB. et al. Computerized medical records and clinic function. MD Comput 1989; 6: 282-7.
- 8 Chute CG. Clinical data retrieval and analysis: I’ve seen a case like that before. Ann New York A cad Sc 1992; 670: 133-40.
- 9 Degoulet P, Chatellier G, Devries C, Lavril M, Menard J. Computer-assisted techniques for evaluation and treatment of hypertensive patients. Am J Hypertension 1990; 3: 156-63.
- 10 Degoulet P, Menard J, Berger C, Plouin PF, Devries C, Hirell JC. Hypertension management: the computer as a participant. AmJ Med 1980; 68: 560-7.
- 11 Demlo LK, Campbell PM, Brown SS. Reliability of information abstracted from patients’ records. Med Care 1978; 16: 995-1005.
- 12 Feinleib M. Data bases, data banks and data dredging: the agony and the ecstasy. J Chron Dis 1984; 37: 783-90.
- 13 Fischer KF, Lees JA, Newman JH. Hypoglycemia in hospitalized patients: causes and outcomes. N Engl J Med 1986; 315: 1245-50.
- 14 Fries JF. ARAMIS Second Progress Report. In: American Rheumatism Association Medical Information System, Palo Alto, CA 1978
- 15 Fries JF. Time-oriented patient records and a computer-databank. JAMA 1972; 222: 1536
- 16 Gremy F. Informatics and medical methodology: random reflections about clinical data bases. Med Inform 1982; 7: 85-91.
- 17 Grossman JH. An ambulatory medical record system for patient care and health care management. Methods Inf Med (Suppl) 1972; 6: 375-82.
- 18 Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 1992; 152: 125-30.
- 19 Hlatky MA, Lee KL, Harrell FE. et al. Tying clinical research to patient care by use of an observational database. Stat Med 1984; 3: 375-87.
- 20 Horowitz GL, Bleich HL. PaperChase: a computer program to search the medical literature. N Engl J Med 1981; 305: 924-30.
- 21 Horowitz GL, Jackson JD, Bleich HL. PaperChase: self-service bibliographic retrieval. JAMA 1983; 250: 2494-99.
- 22 Iezzoni LI. ed. Risk Adjustment for Measuring Health Care Outcomes . Ann Arbor, MI: Health Administration Press; 1994
- 23 Klein LA, Compton CC. A 51-year-old woman with microscopic hematuria and an osteolytic lesion of the spine. N Engl J Med 1986; 314: 500-9.
- 24 Kurland LT, Molgaard CA. The patient record in epidemiology. Sci Am 1981; 245: 54-63.
- 25 Lee TH, Goldman L. Development and analysis of observational data bases. J Am Coli Cardiol 1989; 14: 44A-7A.
- 26 Levkoff SE, Safran C, Cleary PD, Gallop J, Phillips RS. Identification of elderly patients at risk for delirium. J Am Geriatr Soc 1988; 36: 1099-104.
- 27 Mantel N. Cautions on the use of medical databases. Stat Med 1983; 2: 355-62.
- 28 McDonald CJ, Hui SL. The analysis of humongous databases: problems and promises. Stat Med 1991; 10: 511-20.
- 29 McDonald CJ, Blevins L, Tierney WM, Martin DK. The Regenstrief medical records. MD Comput 1988; 5: 34-47.
- 30 McDonald CJ, Murray R, Jeris D. et al. A computer-basedrecord and clinical monitoring system for ambulatory care. Am J Public Health 1977; 67: 240-5.
- 31 Phillips RS, Safran C, Cleary PD, Delbanco TL. Predicting emergency re-admissions for patients discharged from the medical service of a teaching hospital. J Gen Intern Med 1987; 2: 400-5.
- 32 Pryor DB, Califf RM, Harrell FE. et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985; 23: 623-47.
- 33 Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system. J Med Syst 1983; 7: 87-102.
- 34 Pryor TA. The HELP medical record system. MD Comput 1989; 5: 22-33.
- 35 Rector AL, Nowlan WA, Kay S. Foundation for an electronic medical record. Methods Inf Med 1991; 30: 179-86.
- 36 Rosati RA, McNeer JF, Starmer CF, Mittler BS, Morris Jr JJ, Wallace AG. A new information system for medical practice. Arch Intern Med 1975; 135: 1017-24.
- 37 Rosati RA. Tying the output of clinical research to patient care. Proc Annu Meet Med Sect Am Counc Life Insur 1976; 1: 47-60.
- 38 Safran C, Bleich HL, Slack WV. Role of computing in patient care in two hospi tals. MD Comput 1989; 6: 141-8.
- 39 Safran C, Porter D, Lightfoot J. et. al ClinQuery: a system for onlirie searching of data in a teaching hospital. Ann Intern Med 1989; 111: 751-6.
- 40 Safran C, Porter D, Slack WV, Bleich HL. Diagnosis-related groups: a critical assessment of the provision for comorbidity. Med Care 1987; 25: 1011-4.
- 41 Safran C, Porter D. New uses of the large clinical data base at the Beth Israel Hospital: on-line searching by clinicians. In: Proceedings of the 10th Annual Symposium on Computer Applications in Medical Care. . Washington DC: 1986: 114-9.
- 42 Safran C, Rind D, Bakker AR, Citroen M, Slack V, Bleich HL. Protection of confidentiality in the computer-based patient record. MD Comput. 1995. (in press)
- 43 Safran C, Sobel E, Lightfoot J, Porter D. A computer program for interactive searches of a medical data base. In: Salamon R, Blum B, Jorgenson M. eds. MEDINFO 86 Proceedings of the fifth world conference on medical informatics. Amsterdam: Elsevier Science Publishers; 1986: 545-9.
- 44 Safran C. Using routinely collected data for clinical research. Stat Med 1991; 10: 559-64.
- 45 Sands DZ, Safran C, Slack WV, Bleich HL. Use of electronic mail in a teaching hospital. Proc Annu Symp Comput. Appl Med Care 1993: 306-10.
- 46 Scherrer JR, Baud R, Brisebarre EMessmer, Assimacopoulos A. A hospital information system in continuous operation and expansion: concepts, tools and migration. In: Othner HF. ed. Proceedings of the 10th Annual Symposium on Computer Applications in Medical Care. Washington DC: 1986: 120-32.
- 47 Scherrer JR, Baud RH, Hochstrasser D, Ratib R. DIOGENE: an integrated hospital information system. MD Compu 1990; 7: 81-9.
- 48 Stead WW, Hammond WE. Computerized medical records: a new resource for clinical decision making. J Med Syst 1983; 7: 213-20.
- 49 Tierney WM, Martin DK, Greenlee MC. et al. The prognosis of hyponatremia at hospital admission. J Gen Intern Med 1986; 1: 380-5.
- 50 Tierney WM, McDonald CJ. Practice databases and their uses in clinical research. Stat Med 1991; 10: 541-59.
- 51 Vander Lei J, Duisterhout JS, Westerhof HP. et al. The introduction of computer-based patient records in the Netherlands. Ann Intern Med 1993; 119: 1036-41.
- 52 Vander Lei J, Musen MA, van der Does E, Man in’t Veld AJ, van Bemmel JH. Comparison of computer-aided and human review of general practitioners’ management of hypertension. Lancet 1991; 338: 1504-8.
- 53 Warner HR, Olmsted CM, Rutherford BD. HELP: a program for medical decision-making. Com put Biomed Res 1972; 5: 65-74.
- 54 Weed LL. Medical records that guide and teach. N Engl JMed 1968; 278: 593-600.
- 55 Whiting-O’Keefe QE, Simborg DW, Epstein WV, Warger AW. A computerized summary medical record system can provide more information than the standard medical record. JAMA 1985; 254: 1185-92.
- 56 Wyatt J. Clinical data systems, part 1: data and medical records. Lancet 1993; 344: 1543-7.
- 57 Wyatt J. Clinical data systems, part 2: components and techniques. Lancet 1993; 344: 1609-14.
- 58 Wyatt J. Clinical data systems, part 3: data and medical records. Lancet 1993; 344: 1682-8.
- 59 Zwetsloot-Schonk JHM, Snitker p Vandenbroucke JP, Bakker AR. Using hospital information systems for clinical epidemiological research. Med Inform 1989; 14: 53-62.