Development of a new seamless data stream from EMR to EDC system using SS-MIX2 standards applied for observational research in diabetes mellitus

Association between the serum zinc level and nutritional status represented by the geriatric nutritional Rrisk index

BACKGROUND

Although it is widely known that patients with chronic kidney disease (CKD) can develop zinc deficiency, in our previous analysis, the estimated glomerular filtration rate (eGFR) was not independently associated with the serum zinc level. Thus, a post hoc analysis was conducted to investigate the involvement of nutritional status.

METHODS

A total of 655 subjects not on dialysis (402 males; mean age, 57 ± 18 years) who underwent serum zinc level measurements at Jikei University Hospital between April 2018 and March 2019 were selected using the Standardized Structured Medical Information eXchange2 (SS-MIX2) system. In addition, anthropometric data and the Geriatric Nutritional Risk Index (GNRI) representing nutritional status were obtained, and the relationship between the serum zinc level and nutritional status was investigated by multiple regression analysis.

RESULTS

The serum albumin level and the GNRI were lower in the zinc-deficiency group, and both were positively associated with the serum zinc level (rho = 0.44, P < 0.01 and rho = 0.44, P < 0.01, respectively). On multiple regression analysis, the GNRI (t = 3.09, P < 0.01) and serum albumin level (t = 4.75, P < 0.01) were independently associated with the serum zinc level. Although a higher eGFR was associated with a higher serum zinc level, this association disappeared on multivariate analysis.

CONCLUSION

In this post hoc analysis, the GNRI, as well as the serum albumin level, were correlated with the serum zinc level, indicating that nutritional status is an important determinant of the zinc level. Further investigations are needed to clarify the effects of nutritional status and kidney function on zinc deficiency.

Mapping Injection Order Messages to Health Level 7 Fast Healthcare Interoperability Resources to Collate Infusion Pump Data

BACKGROUND

When administering an infusion to a patient, it is necessary to verify that the infusion pump settings are in accordance with the injection orders provided by the physician. However, the infusion rate entered into the infusion pump by the health care provider cannot be automatically reconciled with the injection order information entered into the electronic medical records (EMRs). This is because of the difficulty in linking the infusion rate entered into the infusion pump by the health care provider with the injection order information entered into the EMRs.

OBJECTIVES

This study investigated a data linkage method for reconciling infusion pump settings with injection orders in the EMRs.

METHODS

We devised and implemented a mechanism to convert injection order information into the Health Level 7 Fast Healthcare Interoperability Resources (FHIR), a new health information exchange standard, and match it with an infusion pump management system in a standard and simple manner using a REpresentational State Transfer (REST) application programming interface (API). The injection order information was extracted from Standardized Structured Medical Record Information Exchange version 2 International Organization for Standardization/technical specification 24289:2021 and was converted to the FHIR format using a commercially supplied FHIR conversion module and our own mapping definition. Data were also sent to the infusion pump management system using the REST Web API.

RESULTS

Information necessary for injection implementation in hospital wards can be transferred to FHIR and linked. The infusion pump management system application screen allowed the confirmation that the two pieces of information matched, and it displayed an error message if they did not.

CONCLUSION

Using FHIR, the data linkage between EMRs and infusion pump management systems can be smoothly implemented. We plan to develop a new mechanism that contributes to medical safety through the actual implementation and verification of this matching system.

Use of Electronic Medical Records (EMR) in Gerontology: Benefits, Considerations and a Promising Future

Electronic medical records (EMRs) have many benefits in clinical research in gerontology, enabling data analysis, development of prognostic tools and disease risk prediction. EMRs also offer a range of advantages in clinical practice, such as comprehensive medical records, streamlined communication with healthcare providers, remote data access, and rapid retrieval of test results, ultimately leading to increased efficiency, enhanced patient safety, and improved quality of care in gerontology, which includes benefits like reduced medication use and better patient history taking and physical examination assessments. The use of artificial intelligence (AI) and machine learning (ML) approaches on EMRs can further improve disease diagnosis, symptom classification, and support clinical decision-making. However, there are also challenges related to data quality, data entry errors, as well as the ethics and safety of using AI in healthcare. This article discusses the future of EMRs in gerontology and the application of AI and ML in clinical research. Ethical and legal issues surrounding data sharing and the need for healthcare professionals to critically evaluate and integrate these technologies are also emphasized. The article concludes by discussing the challenges related to the use of EMRs in research as well as in their primary intended use, the daily clinical practice.

Using macros in microsoft excel to facilitate cleaning of research data

Background: Retrospective chart review studies may be delayed by inability to export clean clinical data from an electronic medical record (EMR) or data repository. Macros are pre-programmed procedures that can be used in Microsoft Excel to help streamline the process of cleaning clinical datasets.

Objectives: To demonstrate how macros may be useful for researchers at community hospitals and smaller academic health centers that lack informatics support.

Methods: Using an intrinsic function of our institution’s EMR, vital signs and lab results from 20 individual hospitalizations were exported to a spreadsheet. Two macros were developed to sort through these datasets and output them into a specified format. The speed of macro-assisted data cleaning was compared to manual transcription.

Results: Time spent on data cleaning was significantly reduced when using macro-assisted sorting compared to the manual approach for both vital signs (46.5 seconds versus 12.3 minutes per record, a 94% reduction; P < 0.001) and labs (13.7 seconds versus 2.6 minutes per record, a 91% reduction; P < 0.001).

Conclusions:Macros offer a flexible and efficient tool for cleaning large sets of clinical data, particularly when an institution lacks informatics support or EMR functionality to export clinical data in an analysis-ready format.

MIHARI project, a preceding study of MID-NET, adverse event detection database of Ministry Health of Japan-Validation study of the signal detection of adverse events of drugs using export data from EMR and medical claim data

We studied the effectiveness of the direct data collection from electronic medical records (EMR) when it is used for monitoring adverse drug events and also detection of already known adverse events. In this study, medical claim data and SS-MIX2 standardized storage data were used to identify four diseases (diabetes, dyslipidemia, hyperthyroidism, and acute renal failure) and the validity of the outcome definitions was evaluated by calculating positive predictive values (PPV). The maximum positive predictive value (PPV) for diabetes based on medical claim data was 40.7% and that based on prescription data from SS-MIX2 Standardized Storage was 44.7%. The PPV for dyslipidemia was 50% or higher under either of the conditions. The PPV for hyperthyroidism based on disease name data alone was 20–30%, but exceeded 60% when prescription data was included in the evaluation. Acute renal failure was evaluated using information from medical records in addition to the data. The PPV for acute renal failure based on the data of disease names and laboratory examination results was slightly higher at 53.7% and increased to 80–90% when patients who previously had a high serum creatinine (Cre) level were excluded. When defining a disease, it is important to include the condition specific to the disease; furthermore, it is very useful if laboratory examination results are also included. Therefore, the inclusion of laboratory examination results in the definitions, as in the present study, was considered very useful for the analysis of multi-center SS-MIX2 standardized storage data.

Zinc deficiency: its prevalence and relationship to renal function in Japan

BACKGROUND

Although zinc deficiency is common among dialyzed patients, its prevalence among non-dialyzed subjects and its relationship to renal function remain unclear.

METHODS

We selected 816 non-dialyzed subjects (495 males; mean age, 56 ± 18 years) who underwent measurement of serum zinc at Jikei University Hospital between April 2018 and March 2019 using the Standardized Structured Medical Information eXchange2 (SS-MIX2) system, a global standard in Japan that enables collection of structured medical records with automatic data transfer to a registry database system. A serum zinc level of 60-80 μg/dL was defined as marginal zinc deficiency and a level of < 60 μg/dL as absolute zinc deficiency. We investigated factors associated with serum zinc using multiple regression analysis.

RESULTS

Marginal and absolute zinc deficiency were present in 52.3% and 30.6% of subjects, respectively. Serum zinc levels tended to decrease with increasing stage of chronic kidney disease (CKD) (P = 0.051). Estimated glomerular filtration rate (eGFR) was not independently associated with serum zinc levels. Instead, serum albumin (t = 4.69, P < 0.01), hemoglobin (t = 2.54, P = 0.01) and mean corpuscular volume (MCV) (t = - 2.20, P = 0.03) were independently associated with serum zinc. In sensitivity analyses, serum zinc was not associated with either serum copper- or iron-related parameters.

CONCLUSION

This large-scale study clarified the prevalence of zinc deficiency among non-dialyzed Japanese subjects. In addition, eGFR was not independently associated with serum zinc, probably due to confounding factors, such as nutritional status and degree of anemia. Further investigations are needed to clarify the epidemiology of zinc deficiency and its associations with CKD.

Gap between real-world data and clinical research within hospitals in China: a qualitative study

OBJECTIVE

To investigate the gap between real-world data and clinical research initiated by doctors in China, explore the potential reasons for this gap and collect different stakeholders' suggestions.

DESIGN

This qualitative study involved three types of hospital personnel based on three interview outlines. The data analysis was performed using the constructivist grounded theory analysis process.

SETTING

Six tertiary hospitals (three general hospitals and three specialised hospitals) in Beijing, China, were included.

PARTICIPANTS

In total, 42 doctors from 12 departments, 5 information technology managers and 4 clinical managers were interviewed through stratified purposive sampling.

RESULTS

Electronic medical record data cannot be directly downloaded into clinical research files, which is a major problem in China. The lack of data interoperability, unstructured electronic medical record data and concerns regarding data security create a gap between real-world data and research data. Updating hospital information systems, promoting data standards and establishing an independent clinical research platform may be feasible suggestions for solving the current problems.

CONCLUSIONS

Determining the causes of gaps and targeted solutions could contribute to the development of clinical research in China. This research suggests that updating the hospital information system, promoting data standards and establishing a clinical research platform could promote the use of real-world data in the future.