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. 2024 Dec 27;24(1):408.
doi: 10.1186/s12911-024-02818-3.

Reusing routine electronic health record data for nationwide COVID-19 surveillance in nursing homes: barriers, facilitators, and lessons learned

Y Wieland-Jorna  1   2 , R A Verheij  1   2 , A L Francke  1   3 , R Coppen  1 , S C de Greeff  4 , A Elffers  1 , M G Oosterveld-Vlug  5
Affiliations

Reusing routine electronic health record data for nationwide COVID-19 surveillance in nursing homes: barriers, facilitators, and lessons learned

Y Wieland-Jorna et al. BMC Med Inform Decis Mak. .

Abstract

Background: At the beginning of the COVID-19 pandemic in 2020, little was known about the spread of COVID-19 in Dutch nursing homes while older people were particularly at risk of severe symptoms. Therefore, attempts were made to develop a nationwide COVID-19 repository based on routinely recorded data in the electronic health records (EHRs) of nursing home residents. This study aims to describe the facilitators and barriers encountered during the development of the repository and the lessons learned regarding the reuse of EHR data for surveillance and research purposes.

Methods: Using inductive content analysis, we reviewed 325 documents written and saved during the development of the COVID-19 repository. This included meeting minutes, e-mails, notes made after phone calls with stakeholders, and documents developed to inform stakeholders. We also assessed the fitness for purpose of the data by evaluating the completeness, plausibility, conformity, and timeliness of the data.

Results: Key facilitators found in this study were: 1) inter-organizational collaboration to create support; 2) early and close involvement of EHR software vendors; and 3) coordination and communication between partners. Key barriers that hampered the fitness of EHR data for surveillance were: 1) changes over time in national SARS-CoV-2 testing policy; 2) differences between EHR systems; 3) increased workload in nursing homes and lack of perceived urgency; 4) uncertainty regarding the legal requirements for extracting EHR data; 5) the short notice at which complete and understandable information about the repository had to be developed; and 6) lack of clarity about the differences between various COVID-19 monitors.

Conclusions: Despite the urgent need for information on the spread of SARS-CoV-2 among nursing home residents, setting up a repository based on EHR data proved challenging. The facilitators and barriers found in this study affected the extent to which the data could be used. We formulated nine lessons learned for developing future repositories based on EHR data for surveillance and research purposes. These lessons were in three main areas: legal framework, contextual circumstances, and quality of the data. Currently, these lessons are being applied in setting up a new registry in the nursing home sector.

Keywords: COVID-19; Electronic health records; Nursing homes; Routinely recorded health data; Surveillance.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: According to Dutch legislation (the Medical Research Involving Human Subjects Act (WMO)), ethics approval and consent to participate for this study were not required, because it did not concern medical scientific research, and did not make participants subject to procedures or required them to follow rules of behavior [55]. The legal basis for extracting data from electronic health records was found in the legal obligation of RIVM to prevent and combat infectious diseases as described in the Dutch Public Health Act [34] and RIVM Act [35]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Steps and actors involved in the data flow from data recording in an electronic health record to the reuse of the data as described by Verheij et al. (2018) [14]
Fig. 2
Fig. 2
Timeline for 2020 showing COVID-19 measures in nursing homes and the development of the COVID-19 repository
See this image and copyright information in PMC

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References

    1. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;1(215):108427. - PMC - PubMed
    1. WHO. COVID-19 weekly epidemiological update. World Health Organization; 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update---.... Accessed 02 Feb 2022.
    1. Chowdhury P, Paul SK, Kaisar S, Moktadir MA. COVID-19 pandemic related supply chain studies: A systematic review. Transp Res E Logist Transp Rev. 2021;1(148):102271. - PMC - PubMed
    1. Reeves JJ, Hollandsworth HM, Torriani FJ, Taplitz R, Abeles S, Tai-Seale M, et al. Rapid response to COVID-19: Health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc. 2020;27(6):853–9. - PMC - PubMed
    1. Madhavan S, Bastarache L, Brown JS, Butte AJ, Dorr DA, Embi PJ, et al. Use of electronic health records to support a public health response to the COVID-19 pandemic in the United States: A perspective from 15 academic medical centers. Journal of the American Medical Informatics Association [Internet]. 2021 Feb 15 [cited 2022 Feb 2];28(2):393–401. Available from: https://academic.oup.com/jamia/article/28/2/393/5952684 - PMC - PubMed

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