Use of electronic medical records in oncology outcomes research

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This is a review of an article by Kanas et al. (2010) titled use of electronic medical records in oncology outcomes research. [1]


In this paper, the authors describe how "oncology outcomes research" can benefit from the use of oncology-specific Electronic Medical Records (EMRs) networks.

EMR for oncology research

  • Utility of oncology EMR compared to other available data sources

An ideal oncology EMR would provide several advantages over current research, observational studies, and claims databases. This includes less costly labor and operational funding, more accessible prospectively data collection, permitting analyses of factors from many points during the course of disease, and etc.

  • Relevance to the patient, clinician, and medical researcher

EMR would provide the data for answering the questions about improving health and quality of life (QOL), providing better quality of care, and advancing disease knowledge, which are patients, provides and researchers’ most interests.

  • Relevance to the policy maker

Outcomes research in oncology can provide policy makers the clues to identify deficits in outreach and programmatic spending and current health care resource utilization and accessibility. EMR systems could be a valuable resource for conducting these research studies in oncology.

  • Relevance to the pharmaceutical industry/manufacturer

EMR systems could provide answers to research questions relevant to several groups within the pharmaceutical and biotechnology industries. EMR could potentially provide a set of clinical data to answer questions related to marketing, outcomes research, research and development, phase IV post-marketing, and surveillance.

Challenges of using EMR for oncology research

Challenges can include structural, clinical, and public health research-related issues.

  • Structure

The American Society of Clinical Oncology (ASCO) identified several important elements that should be included in any EMR used by an oncologist: ability to enter staging information, work flow, chemotherapy doses and administration, toxicity assessment, clinical trial management, drug inventory management, and survivor care.

-Interoperability. Without interoperable interfaces, information cannot be exchanged easily, which can affect the work flow for the clinic and could lead to missing information within the medical record and major problems with data quality and completeness.

-Incorporation of different data formats. Due to the variety of sources, data collection may be time intensive, requiring manpower and database management. Natural language algorithms may be necessary to extract the information of interest. Scanned documents and no access to previous paper records are also problematic.

  • Clinical

Variety of diagnostic coding vocabulary and possibly lack of codes, to identify cancer cases or they may miss identifying all cases of a particular cancer. There are concerns of not incorporating records from all specialties providing care.

  • Research-specific

Issues related to the reliability and validity of a study, such as dealing with missing data and generalizability to the source population, as well as ethics and privacy concerns and general accessibility when using an EMR, must be considered

-Missing data. Missing information in the EMR may lead to misclassification of exposure and/or outcome in epidemiologic and other research. The researcher will have to make decisions on completeness of the data set.

-Generalizability. The generalizability of potential research studies to larger populations or to the US in general may be limited.

-Ethical and privacy concerns. The researcher must get the Institutional Review Board (IRB) approval to ensure that the research activity using EMR database protects the privacy and confidentiality of the patients included.

Conclusions and future direction

Secondary uses of EMR data can be useful to many people, including researchers, and will help improve the quality of care through oncology outcome research. This is, however, pertinent on the data being secure and that patient privacy is ensured.

My comments

This paper discussed about the utility of EMR for oncology outcomes research and the challenges of re-use EMR data for research. It did discuss some oncology-specific issues such as structural and clinical issues. However, there are not many viewpoints discussed in this paper are unique for the use of EMR for oncology research. I would be more interested in the oncology-specific challenges and issues of secondary use of EMR for cancer outcomes research.

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  1. Kanas, G., Morimoto, L., Mowat, F., O’Malley, C., Fryzek, J., & Nordyke, R. (2010). Use of electronic medical records in oncology outcomes research.ClinicoEconomics and Outcomes Research : CEOR, 2, 1–14.