Automated data sources for ambulatory care effectiveness research : literature review

84 Pages·1993·6.6 MB·English

by  Grady, Mary L

Bli
Review
iterature
Automated Data Sources
Ambulatory Care
for
Research
Effectiveness
U.S. Department of Health and Human Services
Public Health Service
I**^ AAggeerncyfor Health Care Policy and Research
Department of Health and Human Services
Donna E. Shalala, Ph.D., Secretary
Public Health Service
Audrey F. Manley, M.D., M.P.H., Acting Assistant Secretary for Health
Agency for Health Care Policy and Research
J. Jarrett Clinton, M.D., M.P.H., Administrator
Office of Science and Data Development
J. Michael Fitzmaurice, Ph.D., Director
Literature Review
Automated Data Sources
Ambulatory Care
for
Effectiveness Research
Editors:
Mary Grady
L.
Harvey A. Schwartz, Ph.D.
U.S. Department of Health and Human Services
Public Health Service
Agency for Health Care Policy and Research
May 1993
AHCPR Pub. No. 93-0042
Acknowledgments
Kunitz and Associates, under contract (282-91-0015) to the Agency for
Health Care Policy and Research (AHCPR) conducted the literature
review and prepared the draft manuscript for this publication. We thank
Selma Kunitz, Ph.D., for managing the project; Rene Kozloff, Ph.D., who
wrote the original manuscript; and Julia Sameth, Ruth Heltzer, and Michele
Gargano who did much ofthe searching, sifting, collecting, analyzing, and
verifying necessary to compile this literature review. Thanks also go to
Gerald Cohen and Doris Biscarr ofAHCPRs Office of Science and Data
Development, to former AHCPR staffmembers Edward Vastola, M.D.,
and Marc Stone, M.D., and to the members ofthe advisory panel who
reviewed the manuscript and provided us with comments and suggestions.
Finally, we thank Naomi Levy, ofMoshman Associates, Inc., for editorial
assistance.
ii
Foreword
The Agency for Health Care Policy and Research (AHCPR), through
its Office of Science and Data Development, has been working to provide
greater access to health care data bases, uniform definitions, common
reporting formats and linkages, and standards to ensure security, confiden-
tiality, accuracy, and appropriate maintenance ofdata.
This literature review should provide medical effectiveness researchers
with a valuable tool for identifying and accessing automated medical
records on ambulatory care.
J. Jarrett Clinton, M.D., M.P.H.
Administrator
Agency for Health Care Policy and Research
iii
Preface
Medical effectiveness studies that involve use of automated ambulatory
medical records constitute an emerging field. To date, there has been little
guidance to assist researchers in locating previous studies that employed the
type ofdata ofinterest. This literature review was designed to help fill that
void. It represents a systematic and objective description ofthe available lit-
erature on medical treatment effectiveness in ambulatory settings in which
the researchers have relied substantially on computerized medical records.
The review includes studies that involved the use ofcomputerized records
to identify practice patterns (particularly the effects ofthese patterns on
patient survival, quality oflife, and costs ofcare).
In collecting and describing these resources, emphasis was placed on the
characteristics of the record system and the methodology ofrecord search
and data extraction. Based on information derived from the literature
review, the reader will be able to identify computerized ambulatory record
systems suitable for research, including systems in use in countries other
than the United States.
This literature review provides a basis for discussions oflinkages
between "certain types of data" to proceed based on the general content
and levels oflinkages possible with existing data bases. The descriptions of
the data bases also will facilitate an analysis ofthe usefulness ofcombining
the information contained within different data bases to address additional
medical effectiveness issues.
Harvey A. J. Michael Fitzmaurice,
Schwartz, Ph.D. Ph.D.
Project Officer Director
Office of Science and Office of Science and
Data Development Data Development
Agency for Health Care Agency for Health Care
Policy and Research Policy and Research
iv
Contents
Executive Summary
1
Chapter Ambulatory Care Records Systems and Data Bases
1. 3
Introduction 3
Barriers to Automated Ambulatory Medical Records Systems 4
Existing Automated Ambulatory Medical Records Systems 5
Data Retrieval 6
Data Transmission Standards 8
Implementation Issues 8
Conclusion 9
References and Other Resources 9
Chapter 2. Medical Effectiveness and Health Services Research 19
Introduction 19
Aspects ofMedical Effectiveness Study 19
Efficacy 19
Effectiveness of Medical Practice 20
Variations in Care 20
Outcomes/Measures 22
Quality of Care 24
Summary 25
References and Other Resources 25
Chapter 3. Decisionmaking 29
Introduction 29
The Decisionmaking Process 29
Decision Support Systems 29
Conclusion 30
References and Other Resources 30
Chapter 4. Legal, Confidentiality, and Privacy Issues 33
Introduction 33
Regulatory and Accreditation Issues 33
Use ofMedical Records for Research and Quality Assurance 34
Evidentiary Issues 36
Liability Issues 36
Summary 36
References and Other Resources 37
Chapter 5. Methodological Issues 39
Introduction 39
Data Issues 39
Patients' Issues 40
Bias 40
Addressing Problems with Practice Data Bases 41
References and Other Resources 42
v
Chapter 6. Selected Automated Ambulatory Medical Records Systems 47
—
ARAMIS Arthritis, Rheumatism, and Aging Medical Information System 47
—
ATHOS AIDS Time-Oriented Health Outcome Study 48
—
BICS Brigham and Women's Hospital Integrated Computing System 48
—
BIHS Beth Israel Hospital System 49
—
CIS Clinical Information System 50
—
COSTAR Computer-Stored Ambulatory Record 50
—
DIOGENE Division Informatique Hospital Geneve 51
—
HCHP/AMRS Harvard Community Health Plan, Ambulatory Medical Record System 52
—
HELP Health Evaluation Through Logical Processing 53
—
MARS
Medical Archival System 53
—
PIMS/PI—PS Patient Information Management System / Patient Information Protocol System. . 53
RMRS
RegenstriefMedical Records System 54
—
RPMS Resource and Patient Management System 55
—
STOR Summary Time-Oriented Record 55
—
THERESA Grady Memorial Hospital 56
—
TMR
The Medical Record 56
—
VIPOR Vermont Integrated Problem-Oriented Record 57
References 57
Cumulative Bibliography 59
VI
Executive Summary
A
comprehensive review ofthe literature was per- • Technology issues including hardware, software,
formed to identify automated ambulatory medical research strategies, retrieval mechanisms, and
records systems (AAMRSs), issues relating to query languages.
AAMRSs, and studies of medical effectiveness that
have used automated medical records. In addition • Methodological issues including research ques-
to system descriptions, two major categories ofliter- tions, definitions, operations manuals, quality
ature and materials were identified: (1) empirical control studies, analytic techniques, and statisti-
AAMRSs
studies that are based primarily on and cal considerations.
(2) descriptive literature on policy, methods, and
technology, using MEDLINE, SOCIOFILE, CAT- Materials were gathered and coded and are
LINE, the Directory ofPublished Proceedings and described in this review. Although medical effec-
Proceedings in Print, as well as Congressional tiveness studies that use automated ambulatory
Record Abstracts (CRE—C), PAIS, and LEXIS. medical records are ofmajor interest to the Agency
Uncataloged materials such as recentjourna—ls, for Health Care Policy and Research (AHCPR),
books, abstracts, and conference proceedings also only a few such studies were found, perhaps because
were reviewed, and personal contacts were explored the field is an emerging one.
to identify: Chapter 1 ofthis literature review covers ambu-
• AAMRS descriptions. latory medical record systems, and Chapter 2
reviews medical effectiveness and health services
• Studies using computerized medical records in research studies and issues, as well as quality assur-
ambulatory care settings, especially those detail- ance articles. Chapter 3 describes the use ofauto-
ing practice patterns, process ofcare, outcome,
mated medical records for decisionmaking. Chapter
and costs, in addition to those using computer-
4 addresses legal, confidentiality, and privacy issues;
ized medical records that can be adapted to
and Chapter 5 identifies methodological issues asso-
ambulatory care settings.
ciated with the use of automated ambulatory med-
• Outcome studies including survival, life quality, ical records. Chapter 6 describes selected automated
satisfaction, and health status. ambulatory medical record systems.
1