Abstract
BackgroundRetrospective research requires longitudinal data, and repositories derived from electronic health records (EHR) can be sources of such data. With Health Information Technology for Economic and Clinical Health (HITECH) Act meaningful use provisions, many institutions are expected to adopt EHRs, but may be left with large amounts of financial and historical clinical data, which can differ significantly from data obtained from newer systems, due to lack or inconsistent use of controlled medical terminologies (CMT) in older systems. We examined different approaches for semantic enrichment of financial data with CMT, and integration of clinical data from disparate historical and current sources for research.MethodsSnapshots of financial data from 1999, 2004 and 2009 were mapped automatically to the current inpatient pharmacy catalog, and enriched with RxNorm. Administrative metadata from financial and dispensing systems, RxNorm and two commercial pharmacy vocabularies were used to integrate data from current and historical inpatient pharmacy modules, and the outpatient EHR. Data integration approaches were compared using percentages of automated matches, and effects on cohort size of a retrospective study.ResultsDuring 1999-2009, 71.52%-90.08% of items in use from the financial catalog were enriched using RxNorm; 64.95%-70.37% of items in use from the historical inpatient system were integrated using RxNorm, 85.96%-91.67% using a commercial vocabulary, 87.19%-94.23% using financial metadata, and 77.20%-94.68% using dispensing metadata. During 1999-2009, 48.01%-30.72% of items in use from the outpatient catalog were integrated using RxNorm, and 79.27%-48.60% using a commercial vocabulary. In a cohort of 16304 inpatients obtained from clinical systems, 4172 (25.58%) were found exclusively through integration of historical clinical data, while 15978 (98%) could be identified using semantically enriched financial data.ConclusionsData integration using metadata from financial/dispensing systems and pharmacy vocabularies were comparable. Given the current state of EHR adoption, semantic enrichment of financial data and integration of historical clinical data would allow the repurposing of these data for research. With the push for HITECH meaningful use, institutions that are transitioning to newer EHRs will be able to use their older financial and clinical data for research using these methods.
Highlights
Retrospective research requires longitudinal data, and repositories derived from electronic health records (EHR) can be sources of such data
Among charge codes that had been in use, the most recent snapshot of the financial catalog contained 3226 codes and 94.33% of these items could be matched automatically with orderables in the current inpatient EHR, with a mismatch rate of 1.15%
With HITECH meaningful use requirements, as more hospitals adopt modern EHRs, financial and historical clinical data will remain abundant, and the consolidation, enrichment and integration of such data have the potential for creating large sets of data that can be used for selecting cohorts in retrospective studies, or potentially recruit patients for prospective studies
Summary
Retrospective research requires longitudinal data, and repositories derived from electronic health records (EHR) can be sources of such data. Technology for Economic and Clinical Health (HITECH) act of 2009, more institutions are expected to adopt modern EHR systems [8] In spite of these developments, many institutions will continue to have several years’ worth of financial or historical clinical data, which can differ significantly from data obtained from modern EHR systems. The integration of pharmacy data from different EHR systems [18,19,20], as well as enrichment of financial data with CMT, can allow for semantic normalization and consistent use of such data in research, and provide long-term value to institutions that have large repositories of such data
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