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25.10.2018 1
Using electronic health records
in studying spatial disparities and quality of care
among chronic patients in Siun Sote region
Maija Toivakka​, maija.toivakka@uef.fi
Teppo Repo, teppo.repo@uef.fi
Department of Geographical and Historical Studies,
University of Eastern Finland
Seminar on geospatial data in health and welfare research 23.10.2018 1
Content
1. Electronic health records in health research
• General information
2. Electronic health records in geospatial health research
• Background
• Pros and cons & experiences from Siun Sote
• Screening of type 2 diabetes has improved in the region
3. Implementing research experiences in operational use
• Interface between research and operational use
• Possibilities and challenges
4. Conlcusions
25.10.2018 2
1. Electronic health records in health research
General information
• The use of electronic health records (EHRs) have increased in the past decade.
• EHR: a software platform that contains individual-level patient-provider data captured
during health care encounters.
• Partly patient transactions are routinely collected to health records and partly health
professionals are responsible for recording them.
10/25/2018 3
2. Electronic health records in geospatial health research
Background
• Siun Sote utilizes regional electronic patient register including primary health care and
specialized care – the only regional jointly used register in Finland at the moment.
• In Finland, Current Care Guidelines form the basis of the treatment and management of
diseases and risk factors in health care.
→ The information on treatment outcomes and equity in service use is scarce.
→ It is poorly known how well the clinical guidelines are implemented in practice in different
geographical contexts and what are the real outcomes of care.
• Patient data from regional electronic patient database
- Age, gender, date of birth, address information, laboratory and measurement results, visits in
primary care and special care, diagnosis of diseases, prescriptions
- Geocoded locations of the patients → EHR data becomes spatial data
25.10.2018 4
2. Electronic health records in geospatial health research
Pros and cons & experiences from Siun Sote
• Pros
- Cost-effective data acquisition
- Large “real-world” datasets
- Data is available in near-real time
- Can be easily linked to other data when geocoded
- Comparability to international studies (ICD-10
codes)
• Cons
- Data is not designed for research purposes
- Data quality issues
- Privacy protection
25.10.2018 5
• Large comprehensive patient groups but includes only
patients who have been diagnosed with the disease or have
been treated in the primary/specialized care.
• EHR data becomes spatial data
- Information on the place of domicile.
- Information on current place of domicile only.
- Demographic differences in the region makes
interpretation difficult.
• Enables to use lot of data, but not everything is possible
- EHRs have no personal information on diet or physical activity
- Duration of the disease not available
• Missing data
• Quality of records
• What is a relevant scale for analysing and reporting sensitive EHR data?
• Strict regulations in using and combining other sensitive data (e.g. Statistics
Finland).
2. Electronic health records in geospatial health research
Screening of type 2 diabetes has improved in the region.
25.10.2018 Presentation title / Author 6
3. Implementing research experiences in operational use
Interface between research and operational use
1. Useful spatial information about the current situation of health outcomes and disease
burden comes as a "side product" of academic research.
2. Manually going through patient register data for reports is labor intensive and lacks
continuity.
- Some of the information could be refined automatically and integrated in electronic
heath records (EHR) reporting systems and visualized in a web map services or equivalent.
3. Research should focus also in issues related to operational use and distribution of
geospatial health information.
What further research is needed?
- What kind of (spatial) analysis of (chronic diseases) is meaningful in operational
perspective?
25.10.2018 7
3. Implementing research experiences in operational use
Possibilities and challenges
1. Choosing the health information to be presented in geospatial/map format
- What subjects and spatial scale are relevant for each stakeholder? (decision makers/health
professionals/patients)
2. How personal devices, mobile applications and GEO tracker data could be used, for
example, in T2D/CHD prevention programs and screening?
- New ways to fill the gaps of health-related behavior information in EHR?
3. Is advanced spatial analysis needed in health care planning?
- Location-cost links and spatial econometrics?
- GIS tools developed for other disciplines (e.g. in forestry) could be applied in health care analytics.
• What kind of GIS system or geospatial data is needed in social and welfare sector in
Finland?
25.10.2018 8
4. Conclusions
• Spoiled for choice
- EHRs provide countless opportunities for spatial health research
- Can be easily linked to other geospatial data
• Quality of the recordings is improving
- Less missing data, better comparability locally, regionally, nationally and globally
• Spatial visualizations and spatial analysis could probably be utilized more in
operational use
- Geospatial features should be integrated in EHR reporting systems and data processing
automated
• New ways to fill the gaps of EHR data should be tested
- Supplementary data sources: MyData, individuals privately collected data about health behavior
and locations from mobile apps and (health monitoring) devices, customer satisfaction data
10/25/2018 9
Thank you!
Comments, questions?
25.10.2018 10
References
• Casey, J. A., B. S. Schwartz, W. E. Stewart & N. E. Adler (2016). Using electronic
health records for population health research: A review of methods and applications.
Annual Review of Public Health 37, 61–81.
• Farmer, R., R. Mathur, K. Bhaskaran, S.V. Eastwood, N. Chaturvedi & L. Smeeth
(2018). Promises and pitfalls of electronic health record analysis. Diabetologia 61: 6,
1241–1248.
• Anselin L. Thirty years of spatial econometrics. Papers in Regional Science.
2010;89(1):3-25. doi:10.1111/j.1435-5957.2010.00279.x.
25.10.2018 11

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Maija Toivakka ja Teppo Repo: Using electronic health records in studying spatial disparities and quality of care among chronic patients in Siun Sote region

  • 1. 25.10.2018 1 Using electronic health records in studying spatial disparities and quality of care among chronic patients in Siun Sote region Maija Toivakka​, maija.toivakka@uef.fi Teppo Repo, teppo.repo@uef.fi Department of Geographical and Historical Studies, University of Eastern Finland Seminar on geospatial data in health and welfare research 23.10.2018 1
  • 2. Content 1. Electronic health records in health research • General information 2. Electronic health records in geospatial health research • Background • Pros and cons & experiences from Siun Sote • Screening of type 2 diabetes has improved in the region 3. Implementing research experiences in operational use • Interface between research and operational use • Possibilities and challenges 4. Conlcusions 25.10.2018 2
  • 3. 1. Electronic health records in health research General information • The use of electronic health records (EHRs) have increased in the past decade. • EHR: a software platform that contains individual-level patient-provider data captured during health care encounters. • Partly patient transactions are routinely collected to health records and partly health professionals are responsible for recording them. 10/25/2018 3
  • 4. 2. Electronic health records in geospatial health research Background • Siun Sote utilizes regional electronic patient register including primary health care and specialized care – the only regional jointly used register in Finland at the moment. • In Finland, Current Care Guidelines form the basis of the treatment and management of diseases and risk factors in health care. → The information on treatment outcomes and equity in service use is scarce. → It is poorly known how well the clinical guidelines are implemented in practice in different geographical contexts and what are the real outcomes of care. • Patient data from regional electronic patient database - Age, gender, date of birth, address information, laboratory and measurement results, visits in primary care and special care, diagnosis of diseases, prescriptions - Geocoded locations of the patients → EHR data becomes spatial data 25.10.2018 4
  • 5. 2. Electronic health records in geospatial health research Pros and cons & experiences from Siun Sote • Pros - Cost-effective data acquisition - Large “real-world” datasets - Data is available in near-real time - Can be easily linked to other data when geocoded - Comparability to international studies (ICD-10 codes) • Cons - Data is not designed for research purposes - Data quality issues - Privacy protection 25.10.2018 5 • Large comprehensive patient groups but includes only patients who have been diagnosed with the disease or have been treated in the primary/specialized care. • EHR data becomes spatial data - Information on the place of domicile. - Information on current place of domicile only. - Demographic differences in the region makes interpretation difficult. • Enables to use lot of data, but not everything is possible - EHRs have no personal information on diet or physical activity - Duration of the disease not available • Missing data • Quality of records • What is a relevant scale for analysing and reporting sensitive EHR data? • Strict regulations in using and combining other sensitive data (e.g. Statistics Finland).
  • 6. 2. Electronic health records in geospatial health research Screening of type 2 diabetes has improved in the region. 25.10.2018 Presentation title / Author 6
  • 7. 3. Implementing research experiences in operational use Interface between research and operational use 1. Useful spatial information about the current situation of health outcomes and disease burden comes as a "side product" of academic research. 2. Manually going through patient register data for reports is labor intensive and lacks continuity. - Some of the information could be refined automatically and integrated in electronic heath records (EHR) reporting systems and visualized in a web map services or equivalent. 3. Research should focus also in issues related to operational use and distribution of geospatial health information. What further research is needed? - What kind of (spatial) analysis of (chronic diseases) is meaningful in operational perspective? 25.10.2018 7
  • 8. 3. Implementing research experiences in operational use Possibilities and challenges 1. Choosing the health information to be presented in geospatial/map format - What subjects and spatial scale are relevant for each stakeholder? (decision makers/health professionals/patients) 2. How personal devices, mobile applications and GEO tracker data could be used, for example, in T2D/CHD prevention programs and screening? - New ways to fill the gaps of health-related behavior information in EHR? 3. Is advanced spatial analysis needed in health care planning? - Location-cost links and spatial econometrics? - GIS tools developed for other disciplines (e.g. in forestry) could be applied in health care analytics. • What kind of GIS system or geospatial data is needed in social and welfare sector in Finland? 25.10.2018 8
  • 9. 4. Conclusions • Spoiled for choice - EHRs provide countless opportunities for spatial health research - Can be easily linked to other geospatial data • Quality of the recordings is improving - Less missing data, better comparability locally, regionally, nationally and globally • Spatial visualizations and spatial analysis could probably be utilized more in operational use - Geospatial features should be integrated in EHR reporting systems and data processing automated • New ways to fill the gaps of EHR data should be tested - Supplementary data sources: MyData, individuals privately collected data about health behavior and locations from mobile apps and (health monitoring) devices, customer satisfaction data 10/25/2018 9
  • 11. References • Casey, J. A., B. S. Schwartz, W. E. Stewart & N. E. Adler (2016). Using electronic health records for population health research: A review of methods and applications. Annual Review of Public Health 37, 61–81. • Farmer, R., R. Mathur, K. Bhaskaran, S.V. Eastwood, N. Chaturvedi & L. Smeeth (2018). Promises and pitfalls of electronic health record analysis. Diabetologia 61: 6, 1241–1248. • Anselin L. Thirty years of spatial econometrics. Papers in Regional Science. 2010;89(1):3-25. doi:10.1111/j.1435-5957.2010.00279.x. 25.10.2018 11