Privacy, security, and the public health researcher in the era of electronic health record research

A narrative review on the validity of electronic health record-based research in epidemiology

Electronic health records (EHRs) are widely used in epidemiological research, but the validity of the results is dependent upon the assumptions made about the healthcare system, the patient, and the provider. In this review, we identify four overarching challenges in using EHR-based data for epidemiological analysis, with a particular emphasis on threats to validity. These challenges include representativeness of the EHR to a target population, the availability and interpretability of clinical and non-clinical data, and missing data at both the variable and observation levels. Each challenge reveals layers of assumptions that the epidemiologist is required to make, from the point of patient entry into the healthcare system, to the provider documenting the results of the clinical exam and follow-up of the patient longitudinally; all with the potential to bias the results of analysis of these data. Understanding the extent of as well as remediating potential biases requires a variety of methodological approaches, from traditional sensitivity analyses and validation studies, to newer techniques such as natural language processing. Beyond methods to address these challenges, it will remain crucial for epidemiologists to engage with clinicians and informaticians at their institutions to ensure data quality and accessibility by forming multidisciplinary teams around specific research projects.

On the Convergence of Epidemiology, Biostatistics, and Data Science

Epidemiology, biostatistics, and data science are broad disciplines that incorporate a variety of substantive areas. Common among them is a focus on quantitative approaches for solving intricate problems. When the substantive area is health and health care, the overlap is further cemented. Researchers in these disciplines are fluent in statistics, data management and analysis, and health and medicine, to name but a few competencies. Yet there are important and perhaps mutually exclusive attributes of these fields that warrant a tighter integration. For example, epidemiologists receive substantial training in the science of study design, measurement, and the art of causal inference. Biostatisticians are well versed in the theory and application of methodological techniques, as well as the design and conduct of public health research. Data scientists receive equivalently rigorous training in computational and visualization approaches for high-dimensional data. Compared to data scientists, epidemiologists and biostatisticians may have less expertise in computer science and informatics, while data scientists may benefit from a working knowledge of study design and causal inference. Collaboration and cross-training offer the opportunity to share and learn of the constructs, frameworks, theories, and methods of these fields with the goal of offering fresh and innovate perspectives for tackling challenging problems in health and health care. In this article, we first describe the evolution of these fields focusing on their convergence in the era of electronic health data, notably electronic medical records (EMRs). Next we present how a collaborative team may design, analyze, and implement an EMR-based study. Finally, we review the curricula at leading epidemiology, biostatistics, and data science training programs, identifying gaps and offering suggestions for the fields moving forward.