Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory
Year: 2021
Type: article
Abstract: OBJECTIVE: We identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research. MATERIALS AND METHODS: Since 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements. RESULTS: We received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data. DISCUSSION: Based on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries. CONCLUSION: We are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.
Authors: Rachel L Richesson, Keith S Marsolo, Brian J Douthit, Karen Staman, P Michael Ho, Dana Dailey, Andrew D Boyd, Kathleen M McTigue, Miriam O Ezenwa, Judith M Schlaeger, Crystal L Patil, Keturah R Faurot, Leah Tuzzio, Eric B Larson, Emily C O’Brien, Christina K Zigler, Joshua R Lakin, Alice R Pressman, Jordan M Braciszewski, Corita Grudzen, Guilherme Del Fiol
Institutions: University of Michigan, Michigan Medicine, Duke University, Vanderbilt University, VA Tennessee Valley Healthcare System, University of Colorado Denver, University of Iowa, Saint Ambrose University, University of Illinois Chicago, University of Pittsburgh, University of Florida, University of North Carolina at Chapel Hill, Kaiser Permanente Washington Health Research Institute, Dana-Farber Cancer Institute, Sutter Health, Henry Ford Health, New York University, University of Utah
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,259
Funders: National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, NIH Office of the Director, National Cancer Institute, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Center for Complementary and Integrative Health, Common Fund
Awards: Nonpharmacologic Pain Management in FQHC primary care clinics, G1294528394, G1435497131, Pragmatic trial of population-based programs to prevent suicide attempt, G1544754352, G1566821804, Collaborative Care for Chronic Pain in Primary Care, G2359886319, Nonpharmacologic Pain Management in FQHC primary care clinics, Non-pharmacological Options in postoperative Hospital-based And Rehabilitation pain Management (NOHARM) pragmatic clinical trial, G247302349, G275244132, Primary Palliative Care for Emergency Medicine, G3111920434, G3150879873, HiLo Competitive Renewal, G3588393112, G3660105854, G3906315918, G3907841409, G3989836571, G452087023, A Pragmatic Trial of Lumbar Image Reporting with Epidemiology (LIRE), Pragmatic Trials in Maintenance Hemodialysis, HEAL Collaboratory Resource Coordinating Center (PRISM) (U24), Pragmatic Trial of Acupuncture for Chronic Low Back Pain in Older Adults, G5365733108, Hybrid Effectiveness-Implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain, G5593765148, A Pragmatic Trial of Lumbar Image Reporting with Epidemiology (LIRE), Personalized Patient data and behavioral nudges to improve adherence to chronic cardiovascular medications, G5956646810, G5994049641, Improving Chronic Disease Management with Pieces (ICD-Pieces), G6778084673, PROVEN: PRagmatic trial Of Video Education in Nursing homes, Strategies and Opportunities to Stop Colon Cancer in Priority Populations, A Pragmatic Trial of Parent-focused Prevention in Pediatric Primary Care, G773087094, G7864057360, G7868360915, Group-Based Mindfulness for Patients with Chronic Low Back Pain in the Primary Care, G8016176822, G8132398235, G853377080, Collaborative Care for Chronic Pain in Primary Care, PROVEN: PRagmatic trial Of Video Education in Nursing homes, A Policy Relevant US Trauma Care System Pragmatic Trial for PTSD and Comorbidity, A Pragmatic Trial of Parent-focused Prevention in Pediatric Primary Care: Implementation and Adolescent Health Outcomes in Three Health Systems, G9000031849, G9000032071, G9000079920, G9000129181, G9000131686, G9000140098, G9000226279, G9000247564, G9000308815, G9000326084, G9000353908, G9000355592, G929253898
OpenAlex ID: W3203868315