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Mining electronic health records: towards better research applications and clinical care

Key Points

  • Electronic health record (EHR) systems are increasingly being implemented all over the world, but represent a vast, underused data resource for biomedical research.

  • Structured EHR data, such as encoded diagnosis and medication information, are the easiest data sources to process, but advances in text-mining methods has made it possible to also use the narrative parts of patient records.

  • Statistical studies of the distribution and co-occurrence of clinical features in large collections of patient records enables identification of correlations between, for example, diseases (comorbidities) or between medications and adverse drug reactions.

  • Knowledge-discovery and machine-learning methods can be used both for discovering novel patterns in patient data and for classification and predictive purposes, such as outcome or risk assessment. This has the potential to extend current EHR decision support systems, which integrate available patient data with clinical guidelines to provide assistance to the physician at the point of care.

  • Research platforms built on EHR data, alone or coupled to genotype data, provide an inexpensive and timely way to sample relevant case and control cohorts based on relevant clinical features. As EHR and DNA databases become increasingly interlinked, genotype–phenotype association studies may be designed and conducted by re-using existing data.

  • The growing political focus on the adoption of EHR systems must be accompanied by funding and strategic research into data standards, interoperability and security. Legal matters such as data ownership, privacy and consent need to be addressed to find the right balance between public demands for autonomy and privacy, and manageable procedures for researchers to access data.

  • Fulfilling the full potential of electronic health data for scientific discovery and improved public health will require collaboration across stakeholders and research groups.

Abstract

Clinical data describing the phenotypes and treatment of patients represents an underused data source that has much greater research potential than is currently realized. Mining of electronic health records (EHRs) has the potential for establishing new patient-stratification principles and for revealing unknown disease correlations. Integrating EHR data with genetic data will also give a finer understanding of genotype–phenotype relationships. However, a broad range of ethical, legal and technical reasons currently hinder the systematic deposition of these data in EHRs and their mining. Here, we consider the potential for furthering medical research and clinical care using EHR data and the challenges that must be overcome before this is a reality.

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Figure 1: Electronic health record content.
Figure 2: Four ways to analyse EHR data.

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Acknowledgements

We thank U. Buddrus for kindly providing unpublished data on the adoption of EHR systems in Europe. Any errors in communicating these insights are the sole responsibility of the authors. The authors were supported in part by the Villum Kann Rasmussen Foundation, the Novo Nordisk Foundation and the Danish Research Council for Strategic Research.

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Correspondence to Søren Brunak.

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Glossary

Clinical decision support

(CDS). Software systems providing support for decision making to physicians through the application of health knowledge and logical rules to patient data.

Biobanks

Central repositories of biological material that are mainly used for research. They facilitate the re-use of collected samples in different research projects.

Electronic health records

(EHRs). In this review we do not distinguish between EHRs, Electronic Patient Records (EPRs) and Electronic Medical Records (EMRs).

HITECH act

Part of the American Recovery and Reinvestment act from 2009. The Health Information Technology for Economic and Clinical Health (HITECH) act allocates funding and attention to HIT infrastructure and electronic health record adoption and research in the United States.

ICD

The International Classification of Diseases (ICD) published by the World Health Organization. It has been translated into numerous languages.

Medicare

A US government health insurance programme primarily covering people aged 65 yearsand older.

Charlson index

A measure of the accumulated disease burden for a patient. It is calculated as a weighted sum of 22 selected medical conditions that are assigned scores depending on the severity of the condition.

Pharmacovigilance

Monitoring of adverse drug events during clinical trials and after marketing in order to prevent harm to patients. It is typically based on statistical pattern-finding in databases of reported adverse events.

Adverse drug event

(ADE). Used in pharmacology to describe any unexpected or harmful event associated with a given medication.

Feature vector

The representation of objects (patients) as vectors in the space of all relevant features. Each dimension of the vector specifies the association of a patient with a certain feature.

Clustering

A common task in statistical data exploration using measures of similarity between data points, network topology or other methods to group data points with similar characteristics together in clusters.

Semantic similarity

A measure of the similarity of two concepts in terms of their meaning or semantic content. Often quantified using topological measures of distance in an ontology of concepts, such as WordNet or Systematized Nomenclature of Medicine — Clinical Terms (SNOMED CT).

Electronic Medical Records and Genomics Network

(eMERGE Network). An institutional network that is exploring the potential of electronic health record data in genetic and medical research. Participating institutions are: GroupHealth, Geisinger, Marshfield Clinic, Mayo Clinic, Mount Sinai School of Medicine, Northwestern University and Vanderbilt University.

Pharmacogenomics

The study of how genetic variants influence the effects of drugs on, for example, drug metabolism, efficacy and toxicity, with the goal of improving and personalizing drug therapy.

Million Veteran Program

A research project initiated by the Veterans Affairs Office of Research and Development that is aimed at establishing a database with DNA and health record data from one million people. Participation is opt-in.

Kaiser RPGEH

The Kaiser Permanente Research Project on Genes, Environment and Health (Kaiser RPGEH). This project aims to establish a research database with genetic data, environment data and health record data from 500,000 people. Participation is opt-in.

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Jensen, P., Jensen, L. & Brunak, S. Mining electronic health records: towards better research applications and clinical care. Nat Rev Genet 13, 395–405 (2012). https://doi.org/10.1038/nrg3208

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