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      Next-generation phenotyping of electronic health records

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      Journal of the American Medical Informatics Association : JAMIA
      BMJ Group

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          Abstract

          The national adoption of electronic health records (EHR) promises to make an unprecedented amount of data available for clinical research, but the data are complex, inaccurate, and frequently missing, and the record reflects complex processes aside from the patient's physiological state. We believe that the path forward requires studying the EHR as an object of interest in itself, and that new models, learning from data, and collaboration will lead to efficient use of the valuable information currently locked in health records.

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          Most cited references32

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          The "meaningful use" regulation for electronic health records.

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            Methods and dimensions of electronic health record data quality assessment: enabling reuse for clinical research

            Objective To review the methods and dimensions of data quality assessment in the context of electronic health record (EHR) data reuse for research. Materials and methods A review of the clinical research literature discussing data quality assessment methodology for EHR data was performed. Using an iterative process, the aspects of data quality being measured were abstracted and categorized, as well as the methods of assessment used. Results Five dimensions of data quality were identified, which are completeness, correctness, concordance, plausibility, and currency, and seven broad categories of data quality assessment methods: comparison with gold standards, data element agreement, data source agreement, distribution comparison, validity checks, log review, and element presence. Discussion Examination of the methods by which clinical researchers have investigated the quality and suitability of EHR data for research shows that there are fundamental features of data quality, which may be difficult to measure, as well as proxy dimensions. Researchers interested in the reuse of EHR data for clinical research are recommended to consider the adoption of a consistent taxonomy of EHR data quality, to remain aware of the task-dependence of data quality, to integrate work on data quality assessment from other fields, and to adopt systematic, empirically driven, statistically based methods of data quality assessment. Conclusion There is currently little consistency or potential generalizability in the methods used to assess EHR data quality. If the reuse of EHR data for clinical research is to become accepted, researchers should adopt validated, systematic methods of EHR data quality assessment.
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              Detecting drug interactions from adverse-event reports: interaction between paroxetine and pravastatin increases blood glucose levels.

              The lipid-lowering agent pravastatin and the antidepressant paroxetine are among the most widely prescribed drugs in the world. Unexpected interactions between them could have important public health implications. We mined the US Food and Drug Administration's (FDA's) Adverse Event Reporting System (AERS) for side-effect profiles involving glucose homeostasis and found a surprisingly strong signal for comedication with pravastatin and paroxetine. We retrospectively evaluated changes in blood glucose in 104 patients with diabetes and 135 without diabetes who had received comedication with these two drugs, using data in electronic medical record (EMR) systems of three geographically distinct sites. We assessed the mean random blood glucose levels before and after treatment with the drugs. We found that pravastatin and paroxetine, when administered together, had a synergistic effect on blood glucose. The average increase was 19 mg/dl (1.0 mmol/l) overall, and in those with diabetes it was 48 mg/dl (2.7 mmol/l). In contrast, neither drug administered singly was associated with such changes in glucose levels. An increase in glucose levels is not a general effect of combined therapy with selective serotonin reuptake inhibitors (SSRIs) and statins.
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                Author and article information

                Journal
                J Am Med Inform Assoc
                J Am Med Inform Assoc
                jamia
                amiajnl
                Journal of the American Medical Informatics Association : JAMIA
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1067-5027
                1527-974X
                Jan-Feb 2013
                6 September 2012
                6 September 2012
                : 20
                : 1
                : 117-121
                Affiliations
                Biomedical Informatics, Columbia University, New York, NY, USA
                Author notes
                [Correspondence to ] Dr George Hripcsak, Department of Biomedical Informatics, Columbia University Medical Center, 622 West 168th Street, VC5, New York, NY 10027, USA; hripcsak@ 123456columbia.edu
                Article
                amiajnl-2012-001145
                10.1136/amiajnl-2012-001145
                3555337
                22955496
                076a0be3-2288-4a9b-8607-cf3a41b68b0a
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

                History
                : 5 June 2012
                : 11 August 2012
                Categories
                Focus on Data Sharing
                1506
                Custom metadata
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                Bioinformatics & Computational biology
                Bioinformatics & Computational biology

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