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BMC Medical Research Methodology

, 11:151

First Online: 18 November 2011Received: 17 March 2011Accepted: 18 November 2011


BackgroundRetrospective research requires longitudinal data, and repositories derived from electronic health records EHR can be sources of such data. With Health Information Technology for Economic and Clinical Health HITECH Act meaningful use provisions, many institutions are expected to adopt EHRs, but may be left with large amounts of financial and historical clinical data, which can differ significantly from data obtained from newer systems, due to lack or inconsistent use of controlled medical terminologies CMT in older systems. We examined different approaches for semantic enrichment of financial data with CMT, and integration of clinical data from disparate historical and current sources for research.

MethodsSnapshots of financial data from 1999, 2004 and 2009 were mapped automatically to the current inpatient pharmacy catalog, and enriched with RxNorm. Administrative metadata from financial and dispensing systems, RxNorm and two commercial pharmacy vocabularies were used to integrate data from current and historical inpatient pharmacy modules, and the outpatient EHR. Data integration approaches were compared using percentages of automated matches, and effects on cohort size of a retrospective study.

ResultsDuring 1999-2009, 71.52%-90.08% of items in use from the financial catalog were enriched using RxNorm; 64.95%-70.37% of items in use from the historical inpatient system were integrated using RxNorm, 85.96%-91.67% using a commercial vocabulary, 87.19%-94.23% using financial metadata, and 77.20%-94.68% using dispensing metadata. During 1999-2009, 48.01%-30.72% of items in use from the outpatient catalog were integrated using RxNorm, and 79.27%-48.60% using a commercial vocabulary. In a cohort of 16304 inpatients obtained from clinical systems, 4172 25.58% were found exclusively through integration of historical clinical data, while 15978 98% could be identified using semantically enriched financial data.

ConclusionsData integration using metadata from financial-dispensing systems and pharmacy vocabularies were comparable. Given the current state of EHR adoption, semantic enrichment of financial data and integration of historical clinical data would allow the repurposing of these data for research. With the push for HITECH meaningful use, institutions that are transitioning to newer EHRs will be able to use their older financial and clinical data for research using these methods.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2288-11-151 contains supplementary material, which is available to authorized users.

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Author: Vikrant G Deshmukh - N Brett Sower - Cheri Y Hunter - Joyce A Mitchell


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