Abstract
BackgroundPrimary care electronic medical record (EMR) data are being used for research, surveillance, and clinical monitoring. To broaden the reach and usability of EMR data, case definitions must be specified to identify and characterize important chronic conditions. The purpose of this study is to identify all case definitions for a set of chronic conditions that have been tested and validated in primary care EMR and EMR-linked data. This work will provide a reference list of case definitions, together with their performance metrics, and will identify gaps where new case definitions are needed.MethodsWe will consider a set of 40 chronic conditions, previously identified as potentially important for surveillance in a review of multimorbidity measures. We will perform a systematic search of the published literature to identify studies that describe case definitions for clinical conditions in EMR data and report the performance of these definitions. We will stratify our search by studies that use EMR data alone and those that use EMR-linked data. We will compare the performance of different definitions for the same conditions and explore the influence of data source, jurisdiction, and patient population.DiscussionEMR data from primary care providers can be compiled and used for benefit by the healthcare system. Not only does this work have the potential to further develop disease surveillance and health knowledge, EMR surveillance systems can provide rapid feedback to participating physicians regarding their patients. Existing case definitions will serve as a starting point for the development and validation of new case definitions and will enable better surveillance, research, and practice feedback based on detailed clinical EMR data.Systematic review registrationPROSPERO CRD42016040020
Highlights
Primary care electronic medical record (EMR) data are being used for research, surveillance, and clinical monitoring
Validated disease case definitions have the potential to be modified and applied to various EMR databases to enable better surveillance, research, and practice feedback based on detailed clinical EMR data
The objective of this study is to identify all case definitions for a set of chronic conditions, which have been tested and validated in primary care EMR and EMRlinked data
Summary
We will perform a systematic review following a predetermined protocol, in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) reporting guidelines [9]. Articles that report original data for the development and validation of chronic disease case definitions in primary care EMR data or EMR-linked data will be. The following data elements will be extracted: publication date, first author, country, EMR platform, administrative data sources (in the case of linked studies), description of case definition, disease(s) under study, and measures of validity (e.g., sensitivity, specificity). We will use relevant items from the QUADAS quality assessment tool for diagnostic accuracy studies [12] This tool includes an assessment of bias in several domains, including patient selection, the validation strategy, and reporting of outcomes. Results from included studies will be described in detail, grouped by disease or health condition, and reported for EMR and EMR-linked data separately. Within disease conditions for which there is more than one validated case definition, we will perform a descriptive analysis that compares the specifications of the case definitions and their relative performance
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