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The Promise of Structured Data Capture

April 25, 2013
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Leveraging EHR data to supplement data collected for research, patient safety, and public health

In a recent blog post I quoted Vanderbilt University biomedical informatics professor Chris Lehmann, M.D., as saying “the biggest waste in the healthcare system is not unnecessary treatment or duplicated test results; it is that we collect data and never use it again.”

In a way this topic came up again at last week’s Health IT Standards Committee meeting. Doug Fridsma, MD, PhD, chief science officer for the Office of the National Coordinator for Health IT, gave a presentation on ONC’s progress on structured data capture.

He noted that there is strong public and private interest in leveraging clinical data captured in the health record during episodes of care to supplement data collected for other purposes, including research, patient safety event reporting, and public health reporting. Aggregated and analyzed EHR data could be used to identify trends, predict outcomes and influence patient care, drug development and therapy choices, Fridsma said.

To date, however, the use of EHR data for supplemental purposes has been limited due to a lack of uniformity in the terminology and definitions of data elements across EHRs. This limitation is compounded by the fact that clinician workflow often records patient information in unstructured free-text data after the episodes of care.

So if a standard can be established, it would enable patient information to flow from EHRs to other systems: research consortia, registries, bio repositories, and public health systems. The idea is that asecure, single-point data entry could populate multiple systems, including public health agencies.

That is where ONC’s Structured Data Capture Initiative comes in. Its goal is to develop and validate a standards-based data architecture so that a structured set of data can be accessed from EHRs and stored for merger with comparable data for other relevant purposes, including the electronic case report form (eCRF) used for clinical research and the incident report used for patient safety reporting, and the surveillance case report form used for public health reporting of infectious diseases.

The initiative, launched on Jan. 23, 2013, has 200 registered community members and strong participation from an alphabet soup of federal agencies including NIH, AHRQ, FDA, CMS, CDC and SAMSHA.

Fridsma said the initiative’s goal is to identify, evaluate and harmonize four new standards that will enable EHRs to capture and store structured data:

1. Standard for the structure of the common data elements that will be used to fill the specified forms or templates.

2. Standard for the structure or design of the form or template (container) that common data elements can sit in.

3. Standard for how EHRs interact with the form or template.

4. Standard to auto-populate form or template

This promising initiative is off to a good start, with lots of community involvement in review and in voting on a final project charter, Fridsma said. It has kicked off a use-case development phase and is continuing outreach to other potential stakeholders. This is an effort worth keeping an eye on. We’ll check in with them this summer for a progress report.