how to extract data from ehr

06 Dec 2020

First, it was established which indicators could be extracted from the EHRs. PubMed Google Scholar. As we are matching the indicator scores of therapists calculated from survey data to the indicator scores of that same therapist calculated from EHR data, the scores should match if the data collection method was of no influence. This showed that even when controlling for these characteristics, the differences between indicator scores in the EHR data and the survey data were similar to the results presented in Table 5. (red.). A limitation in using EHR software was the difference in designs of the EHRs. A systematic review on how medical registries provide information feedback to health care providers. J Am Med Inform Assoc. also states [16]. Also, some EHR software suppliers already had their own standard list of treatment interventions, while most of them used a text field. These results are equal to the results in Table 4. For the NIH Health Care Systems Research Collaboratory Biostatistics and Study Design Core. Using electronic health records to measure physician performance for acute conditions in primary care: empirical evaluation of the community-acquired pneumonia clinical quality measure set. Or, the process of extracting elements of data from a source document or database and entering them into an automated system. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated. Amersfoort, The Netherlands: Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF) 2011. Experts within the focus group objected to the limited list of treatment interventions to choose from. Therefore, these categories were combined. linking data from different sources, 5) assessing the quality of the data, 6) managing the data for the duration of a given study, and 7) archiving or sharing data after a study. The importance of data comparability within the EHRs itself for reliable and valid quality measurement comparisons has been previously recognized [8, 9]. If software differences between the various EHRs are overcome to deliver standardized output and the process of extracting the data from the EHRs is automated, quality managers can use the quality information when it suits them instead of waiting for the results of a study or a report to act on them more promptly. As a result of the discussion in the focus group to make the EHRs suitable to extract data for the quality assessment, a decision was made which of the eight original quality indicators (see Table 2) could be successfully extracted from the EHRs. Resource: Capturing High Quality Electronic Health Records Data to Support Performance Improvement (PDF, 2.3 MB, 73 pages) This learning guide explains how to improve electronic health record (EHR) data quality to stimulate practice quality improvement, an aspect of Key Driver 3: Optimize health information systems to extract data … Research has indicated that feedback can be used to improve the quality of care, showing improvements after feedback initiatives on process or outcome of care, although the effectiveness of feedback initiatives does depend on the (perceived) quality of the data and the willingness of the recipients [15]. In a more recent review describing the reliability and validity of EHR data, 35 studies were reviewed, of which only four compared EHR data quality to survey data [3]. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. This person will likely be involved in bringing the rest of the team in and helping you navigate through the system. However, to support the use of EHR data for quality measurements over the use of conventional data sources such as administrative data, patient surveys or provider surveys, a stronger evidence base is needed with respect to data attributes relevant for these measurements [3–5]. MS, PJvdW, MWGNvdSN and JB conceived of and designed the study. The cleaned, standardized data is then ready to be deposited into a registry of Cleveland Clinic clinical research data. 1999;282:1184–90. In the survey data, physical therapists selected from cases that were already closed, so they could select any case, including chronic cases that was closed in the last year. Van Dulmen SA, Tacken MAJB, Staal JB, et al. With the emergence of the electronic health records (EHRs) as a pervasive healthcare information technology, [1] new opportunities and challenges for use of clinical data arise with respect to data quality, data availability and comparability [2]. Data extraction from electronic health records (EHRs) for quality measurement of the physical therapy process: comparison between EHR data and survey data. Allet L, Bürge E, Monnin D. ICF: Clinical relevance for physiotherapy? for describing patient goals for example, can be analysed and used for a more content-based quality measurement. The process of extracting information from a document to create a brief summary of a patient's illness, treatment, and outcome. One is the Health … Although these tools can be successful, it requires a considerable user involvement [1]. At the least it can help mistakes be more easily retrieved, increasing transparency and accountability. Quality criteria were proposed for measurement properties of health status questionnaires. However, since the differences between indicator scores calculated from survey data and EHR data are relatively small (or in the case of indicator 1 even negative), we consider the time effect not to be a major influence on the results. A simpler, dictionary-based term recognition tool can be used, as these are easier to use and with more speed than more advanced NPL tools [21]. There was no significant difference between EHR data and survey data on indicator 8, when we controlled for the patient, therapist and practice characteristics. As a practice facilitator, you will need to be familiar with various EHR products and how to extract data from them. During this process, it is critical that you understand the context of the EHR data and know what parameters you might use to create a data … The data quality of the indicators that we could compare showed that the EHR data was more complete than survey data on three out of four indicators and indicators based on EHR data seemed to be as accurate or correct as the indicators based on survey data on three out of four indicators. Correspondence to The biggest problem in the indicators were the high ceiling effects, as mentioned before [11, 20]. In the transition from using survey data to using EHR data for quality measurements, decisions were made by the focus group that affected the quality indicator set at three levels. Med Care. similarity in data quality and availability of measurement components in different data sources [3]. Google Scholar. Standardization of the format of EHRs, the use of a standardized coding and exploring text mining tools require a considerable effort from the physiotherapy community, researchers and EHR developers. In a trade-off between a deeper linguistic understanding and computational efficiency, Jung et al. A mean score of all the patient case scores would then be calculated to reach the indicator score at therapist level. EHR data also proved to be correct; the relative change in indicator scores between EHR and survey data were small (<5 %) in three out of four QIs. Ned Tijdschr Fysiother. PubMed  These differences within EHR data must be overcome to ensure that physiotherapy practices can be compared on quality of care by standardizing the design, or the EHR software supplier must be controlled for in comparative research. The indicator set contained eight indicators for the quality of the physical therapy care process, one for every step in the clinical reasoning process. This posed a problem as it was thus more difficult to distinguish between different physical therapists on the level of their quality, but also that it would be difficult to establish relevant change over time within the same therapist. There were 15 different EHR suppliers and two third (68.4 %) of the participating practices used one of the two largest EHR suppliers. For example; an indicator was calculated from 2 items in the survey. Google Scholar. Completeness of indicator 2 (screening and diagnosis of referred patients) is 8 percent lower for EHR data (p < 0.001). In the end, four out of the original eight indicators were comparable. Scholte M, Neeleman-van der Steen CWM, Hendriks EJM, et al. The use of the ICF in coding problems in functioning of patients would assist in establishing reliable comparisons for estimating the quality of care, although preliminary training is required to use the ICF correctly [23]. Chan KS, Fowles JB, Weiner JP. To decrease the registration burden, most quality measures are restricted to the structured coded data. Article  Another QI proved incomparable due to errors in the extraction software of some of the EHRs. The experts from the focus group concluded that it was therefore not a valuable proxy for quality of care, given that the quality indicators were meant to be generic so that broad comparisons could be made at the level of physical therapists, as opposed to specific indicators that could compare quality at the level of the patient (or the condition of the patient)., DOI: Data … PubMed  Indicator 4 would not be included in the set to be extracted from the EHRs, because of the narrative character of this registration. Terwee CB, Bot SDM, de Boer MR, et al. Our study showed that changes in data collection methods from survey data to data extracted from EHRs had a major impact on the comparability of the content. Cijfers uit de registratie van fysiotherapeuten. Other properties are different aspects of reliability, validity and reproducibility of the data, as Terwee et al. The communication process with the patient might be harder to remember for the physical therapist than the steps in clinical reasoning, resulting in more missing values on this indicator. Functional evaluation of out-of-the-box text-mining tools for data-mining tasks. A critical review. Descriptive statistics were used to present characteristics of the patients, physiotherapists and physiotherapy practices in both data sets. [20] for example proposed. To mine the raw Epic EHR and then use it to build robust datasets for statistical analysis, the team uses a number of statistical techniques to clean, parse and map the data. What can we learn from incidents in a dutch exploratory cohort study? The information in most EHRs can be distinguished in structured coded data and unstructured narrative data [3, 6]. The third is defining data parameters for creating EHR data extractions. Zhou L, Soran CS, Jenter CA, et al. 2007;60:34–42. I am trying to understand the best way to extract our data from Epic to SQL Server with an ETL process or push subsets of the data … The EHR data showed to be significantly different (p < 0.001) compared to survey data on all four indicators with respect to completeness (Table 4). Practices that did not participate in 2009 were urged to do so by the KNGF and health insurers in 2010. To compare the data quality of the two methods, only physical therapists that had participated in both the survey cohort (2009/2010) and in the EHR cohort (2011) remained in this study sample. To calculate completeness, the number of patient cases per therapist that did not have any missing values on one of the items of an indicator (nominator) was divided by the total number of patient cases per therapists on that indicator (denominator) leading to a proportional score between 0 and 1 for each indicator. Article  St Heal T. 2004;107:1053–7. Submission of Clinical Research Data Contained in EHRs and Other Health IT Systems for General Purpose or Preserving Specific FDA Requirements; Submission of Clinical Research Data to FDA to Support Product Marketing Applications; Submit Adverse Event Report from an Electronic Health Record … Tang PC, Ralston M, Fernandez Arrigotti M, et al. Gender and age of the patient were only extracted in half of the patient cases. The experts decided to omit indicator 4 (clinical reasoning during the intervention process; defining and administrating intervention goals, interventions, and intervention results) and indicator 7 (measured intervention results by the use of measurement instruments), to combine indicator 5 (intervention results administered) and indicator 6 (perceived intervention results) and to extract a simpler form of indicator 8 (information shared with patient) out of the EHRs. The team has over ten years of experience extracting data from eClinicalWorks and migrating data into eClinicalWorks. EHRs present a possibility for continuous and automated data extraction for real time monitoring of the quality of care and for providing direct feedback to patients, medical professionals and health insurance companies. Comparability of the data quality must be assessed with respect to completeness and correctness. Privacy EHR data warehouses allow organizations to derive health statistics and research care trends. Int J Med Inform. Data gathered from patient EHRs (which, by definition, are not purposely designed or optimized to support research activities) may have higher rates of missingness and error than data captured with purpose-built systems and subjected to “cleaning” and validation. extracting data from Epic EMR system I'm looking to connect with a customer or gain some insight from any users that leverage Epic (Electronic Medical Record system) as a data source. Further, construct validity was positively assessed as well as reproducibility and interpretability [11]. Indicators 4 (defining and administrating intervention) and 7 (objectified result, by use of measurement instrument) for example could not be extracted from the EHRs because there was not enough time within the project to classify the possible interventions and the measurement instruments that could, or should be used in each case. Manage cookies/Do not sell my data we use in the preference centre. The use of text-mining tools allows clinicians to maintain a level of narrative information so that he can use his own words to describe his patient to administrate the treatment, while researchers can encode this information to measure the quality of care. Jun 2 2020. As there turned out to be a high level of ceiling effects (therapists with a maximum mean score on an indicator) [11], it was decided that the definition of the quality indicators should be dichotomized: either the physical therapist followed all the steps in clinical reasoning, for example with regard to the screening and diagnostic processes, or he or she did not. By Kathy Sucich, director of healthcare marketing, Dimensional Insight. Telegenisys can help you migrate to a replacement EHR and archive data in your existing/legacy EHR. There are a few ways that you can do this. Meaningful Use program emphasizes improvements in standards around data capture, current EHR- derived quality measurement has limitations due to several factors, most notably variations in EHR content, structure and data format, as well as local data … One of the reasons behind the relatively small differences between indicator scores in survey data and EHR data could be the presence of ceiling effects. Using the EHRs for quality measurements saves valuable time as clinicians do not have to complete additional surveys for quality assessments next to the regular administration of their patients. A standardized EHR can be used for continuous measurement of the quality of care, and for providing real-time feedback to all stakeholders. However, EHRs are normally completed during or right after the consult with the patient, making it easier to answer questions on the communication process with the patient. It is also possible that since the data sources are of different time frames, but with the same physical therapists, changes in indicator scores are caused by a time effect. DET2, which extracts from EHR1 and EHR2 2. The original quality indicators and the items are based on guidelines that addressed the registration of the clinical reasoning process [10] and were tested on validity and reliability [11]. The final result of the transition from using survey data to using EHR data was that survey data could be compared to EHR data with respect to completeness and correctness on four indicators; screening and diagnosis for self-referred patients (indicator 1) and for referred patients (indicator 2), goal setting (indicator 3), and information shared with and agreed upon by the patient (indicator 8). Completeness was defined as ‘the proportion of patient cases without missing values at item level’. It can be argued that physician-reported survey data represent a more holistic view on the quality of care delivered. I know when healthcare organizations analyze data it's common to extract it from an EHR, such as EPIC, and put it into Excel, then reporting to programs like Crystal Reports. Terms and Conditions, concluded that comparability, both of EHR data to other data sources, as well as comparability between EHRs was of importance to valid care quality comparisons and outcome research [3]. Ambiguous and inconsistent operationalisations of two of the largest EHR software providers caused errors in data extraction that further limited comparability. Beroepsmonitor Fysiotherapie. The authors declare that they have no competing interests. Botsis T, Hartvigsen G, Chen F, et al. Second, the definition and calculation of the quality indicators were modified and last, changes at item level were made. volume 16, Article number: 141 (2016) Description Qualiphy project. Int J Qual Health C. 2014;26:261–70. acknowledged another dimension of quality assessment which is data comparability, i.e. Springer Nature. J Clin Epidemiol. Linder JA, Kaleba EO, Kmetik KS. Healthy and Better Again. Different data attributes or dimensions of quality were studied with a great variety in terms used to describe those data attributes [3, 4]. EHRs have the option to administrate narrative data, but natural language processing tools are needed to quantify these text boxes. Another implication of this study is the need for effective natural language programming (NLP) tools. Extracting data from eClinicalWorks is complex as the nature of data structure and storage is non-traditional. Van der Veer SN, de Keizer NF, Ravelli AC, et al. Further, indicator 8 (information shared with and agreed upon by patients) showed the largest improvement on completeness. Survey data had to be recalculated to fit the redefined quality indicators from the EHR data. Despite the uniform extraction algorithm, two of the largest EHR suppliers deviated from this algorithm. Although the indicator scores of the EHR data are significantly different (p < 0.001) from the indicator scores of the survey data (Table 5), only the difference in indicator 1 (screening and diagnosis for self referred patients) is above the 5 percent threshold of relevant difference with a decrease in indicator score of 8.4 percent in the EHR data. In most studies, completeness (i.e. With these tools, text boxes in the EHR, e.g. PubMed  A survey is specifically designed to measure the quality of care, whereas most EHRs are developed for much broader purposes, such as administration, reporting and clinical reasoning. The number of solo practitioners in both the survey as in the EHR data was underrepresented, and the larger practices were overrepresented [14]. Participants can extract data from the centralized repository, add the information to their own EHR data, or track patient outcomes. Key Issues in Extracting Usable Data from Electronic Health Records for … BMC Medical Informatics and Decision Making Wederom Gezond en Beter. The use of classification systems will transform the EHR from an ad-hoc extraction system for quality research, into a proactive documentation support system to improve the administration of health data upfront, as proposed by Botsis et al [1]. A 2018 study using 2014 Healthcare Information and Management Systems Society’s (HIMSS) ambulatory practice survey data reviewed EHR … billing software. Although study data extraction allows PCTs to be performed quickly and at less expense than traditional RCTs that establish redundant parallel data capture systems, they also introduce methodological and logistical challenges, such as those described in the white paper, Assessing Data Quality for Healthcare Systems Data Used in Clinical Research. However, limitations of the technology can make these efforts more difficult to achieve. 2012;33:84–6. In a recent review on methods and dimensions of quality assessment of EHR data, out of 95 reviewed articles 57 conducted comparative research of which only nine compared EHR data to survey data or patient interviews [7]. The indicator score would then be calculated as followed: actual score/maximum possible score. Indicator 1 and 2 (screening and diagnosis) show a lower indicator score in the EHR data, while indicators 3 (goal setting) and 8 (information shared with and agreed upon by patients) have slightly higher indicator scores in the EHR data when compared to the survey data. Both items in our example would now have a 0-1 scoring possibility and only when the physical therapist scored a patient case with the value 1 on both items, the indicator score for that patient case would be 1. Med Care Res Rev. With the emergence of the electronic health records (EHRs) as a pervasive healthcare information technology, new opportunities and challenges for use of clinical data for quality measurements arise with respect to data quality, data availability and comparability. Int J Healthcare Qual Assur Inc Leadersh Health Serv. Data extraction is the critical first-step when replacing one EHR with another. Completeness of EHR data is significantly … Research suggests that visualization tools could have a positive effect on the number of missing values in EHRs [19]. KNGF. A guide on how to develop an international classification of functioning, disability and health core set. Rapport, Editie 2010 (Royal Dutch Society for Physical Therapy (KNGF). Although correctness of indicator 3 (goal setting) is also significantly higher in the EHR data (p < 0.001), the relative change is less than 5 % (4.1 %). So this proportional score would mean that the therapist followed the clinical steps for indicator 1 for 66.7 %. In 2011, data was extracted directly from EHRs. In the EHR however, the item scores and the indicator scores were dichotomous instead of proportional. Dean BB, Lam J, Natoli JL, et al. Infect Control Hosp Epidemiol. Article  92.5 % of participating practices used an EHR from one of the five largest suppliers. However, due to enormous pressure from different stakeholders for a rapid implementation, the pilot phase was skipped with all its consequences. Mi7 can help. Divided by the maximum possible score (3), the indicator score would be 2/3 = 0.67. Reference in this Web site to any specific commercial products, process, service, manufacturer, or company does not constitute its endorsement or recommendation by the U.S. Government or National Institutes of Health (NIH). The vendor of the current EMH system is often not willing to share more than the legally-required level of information, so the new vendor must rely on either a proprietary data extract or a batch of patient CCDA files (CCDA is an export format for patient summary data, which all EHR … In our example, item 1 would remain the same, but item 2 had to be dichotomized. This indicator was already part of a patient survey and it was deemed redundant to ask the professional in such an elaborate way. Because we used de-identified data, our study was deemed exempt from review by the Medical Ethical Committee Arnhem and Nijmegen. All authors read and approved the final manuscript. January 16, 2019: Made nonsubstantive changes to the text as part of the annual content update (changes made by D. Seils). It could therefore have been of great interest for comparisons. EHRs have the potential to provide real time feedback to professionals and quality measurements for research, but more effort is needed to create unambiguous and uniform information and to unlock written text in a standardized manner. At the same time, we advice the use of standardized coding with a search function as another possibility for a more content-based quality measurement. Fortunately, resources are available for both you and your practices. 2008;77:291–304. Living Textbook chapter describing considerations for the use of EHR data in pragmatic trials, Key Issues in Extracting Usable Data from Electronic Health Records for Pragmatic Clinical Trials Our research question therefore is: ‘To what extent is data extracted from EHRs comparable to survey data with respect to content and data quality for scoring QIs’? July 2, 2020: Minor corrections to layout and formatting (changes made by D. Seils). Additional information on the project “Quality Indicators for Physical Therapy”. Complaints in physiotherapy are usually situational and activity related, and by this specific set of coding, it can help the physical therapist in deciding which intervention is needed and what outcome is achievable, and at the same time it can also help the quality research to step up to more content-based quality measurements [24].

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