Virtually Priceless Thoughts

There is an expectation that as we develop and use electronic systems (e.g. EMRs, PHRs etc) that this “will yield a wealth of available data that we can exploit meaningfully to strengthen knowledge building and evidence creation, and ultimately improve clinical and preventive care.”

Leveraging data that is in EMRs makes sense for a PCRN at this point in time. The question of this point is would a PCRN rely only on data that is routinely collected as part of care vs. using both data that is routinely collected as well as specific information that is collected for a given study.

Paper networks would send out specific questionnaires or data collection forms. These could be easily “integrated” into the paper chart (by photocopying). As long as the pages were 8 1/2″ x 11″ (in North America at least), then they fit all the standards they needed to fit.

In the EMR world, it is more complex.

Here are some pros and cons to each approach:

• Routinely collected data
  • May be more variable (I may document less than you routinely or I may be in the habit of documenting elements as text rather than using existing templates
  • May be structured differently between EMRs
  • Could have evolved over time
  • May not capture what a study needs to know
  • Typically is not sufficient for interventional studies
  • May have ethical considerations if retrospective data is used for research.
• Specifically Collected Data
  • Requires more of the EMRs in the network to be able to at the least provide specific templates to record additional data
    • Cost could be more if EMR vendors are required to build in custom features to handle the display of these study questions.
  • Data models for the study may conflict with the data model in the EMR (e.g. smoking — the study might require a detailed description in pack years where as the EMR might have taken a different approach. How are these data reconciled in the EMR?)
  • Requires more from the end user — they have to be keen enough to record some amount of extra data. While it might be minimal, even minimal can add up.
  • Requires a change in work flow (e.g. the clinician now documents additional information, may have to ask different questions, etc.)
  • The data is better suited to the study question
  • The data is potentially more consistent across EMRs
  • It is easier to assess data quality for specific data

There are several things that need to be worked out if one wants to start collecting specific study data. It is an important part of the overall design of a network and depends on the kinds of questions the network wants to ask.