Promises and pitfalls of electronic health record analysis

Abstract

Routinely collected electronic health records (EHRs) are increasingly used for research. With their use comes the opportunity for large-scale, high-quality studies that can address questions not easily answered by randomised clinical trials or classical cohort studies involving bespoke data collection. However, the use of EHRs generates challenges in terms of ensuring methodological rigour, a potential problem when studying complex chronic diseases such as diabetes. This review describes the promises and potential of EHRs in the context of diabetes research and outlines key areas for caution with examples. We consider the difficulties in identifying and classifying diabetes patients, in distinguishing between prevalent and incident cases and in dealing with the complexities of diabetes progression and treatment. We also discuss the dangers of introducing time-related biases and describe the problems of inconsistent data recording, missing data and confounding. Throughout, we provide practical recommendations for good practice in conducting EHR studies and interpreting their results.

Technology in Diabetes Treatment: Update and Future

“…In summary, electronic teaching and applications for smart devices address several aspects of diabetes treatment (59,61,62). These are:…”

“…Mostly there is no possibility for communication and collaboration between "learner" and teacher (diabetes educator, physician) or other peers. Other applications store the data, offer interactive use, allow an adaption toward the users' preferences and profiles and apply recommendations (59,61,62). This is an important limitation for reflective learning (63)(64)(65)(66).…”

“…In general, electronic or online programs were completed in a one-on-one relationship with the computers or smartphones. Some applications are also able to interact with algorithms for the calculation of drug dose (i.e., insulin dose adaption) (59,61,62). The first studies about clinical use of electronic and online treatment programs failed to have high levels of uptake, but they also demonstrated a comparable effect to programs with conventional teaching and learning (67)(68)(69)(70).…”

“…This is an important limitation for reflective learning (63)(64)(65)(66). They can instruct the patients to do "good" activity and to increase frequency and intensity when a weight reduction is desirable (59,61,62,75). These results may lead to the conclusion that up to the present, electronic programs are not superior, but they are rather suitable in patients who do not have easy access to participate in a face-toface teaching and treatment programs.…”

“…The first studies about clinical use of electronic and online treatment programs failed to have high levels of uptake, but they also demonstrated a comparable effect to programs with conventional teaching and learning (67)(68)(69)(70). They are able to coach patients, to improve adherence to self-control of glucose levels, to medication and insulin application (59,61,62). Moreover, electronic programs may be effective tools for refreshment of diabetes knowledge (67-69).…”