Improving the relevance, rigor, and timeliness of evidence on the comparative effectiveness of health care treatments and strategies is a critical goal for comparative effectiveness research (CER).1 As a part of the $1.1 billion in support for CER through the American Recovery and Reinvestment Act, approximately $100 million was provided to build a more robust and flexible infrastructure for conducting CER using prospective electronic clinical data.2 With support from the Agency for Healthcare Research and Quality (AHRQ), AcademyHealth has convened the Electronic Data Methods (EDM) Forum to identify, synthesize, and share lessons learned from 11 projects that are building infrastructure and using electronic clinical data for CER and patient-centered outcomes research (PCOR). In its activities, the EDM Forum considers 4 domains: analytic methods, clinical informatics, data governance, and CER and the learning health care system.
This report provides a brief review of the research networks participating in the EDM Forum and is based on an environmental scan conducted by the EDM Forum. EDM Forum staff conducted a text review of the AHRQ funding opportunity announcements for the 3 grant programs,3–5 research plans of the 11 research projects, and information available on the projects’ websites (if applicable), and attended overview presentations of each project (facilitated by the EDM Forum). These efforts contributed to a deeper understanding of the projects participating in the EDM Forum. In some instances, EDM Forum staff participated in phone calls with project principal investigators, affiliated partners, and AHRQ staff (including the project officer), and synthesized information was confirmed and/or refined during a set of site visits conducted at 6 of the projects in the spring of 2011.
As described in Dr Gurvaneet Randhawa’s a report in this special issue, the projects are supported through 3 grant programs, The Prospective Outcome Systems using Patient-specific Electronic data to Compare Tests and therapies (PROSPECT), Scalable Distributed Research Network (DRN) for CER, and the Enhanced Registry for Quality Improvement (QI) and CER projects. An esteemed, multidisciplinary group of researchers are engaged in these projects. An organizational chart and full list of project titles and investigators is available at http://www.edm-forum.org.6
The goal of these research programs is to build a flexible infrastructure that can be leveraged to address some of the common problems in traditional research studies (both randomized controlled trials and observational studies) and data sources (administrative claims data and electronic health records).3–5 Table 1 provides a framework of common challenges for CER that have been enumerated by grantees and stakeholders. The table addresses the limitations of traditional randomized control trials and observational studies, as well as the use of claims-based data and clinical data collected at the point-of-care (eg, electronic health records) for CER.
To harness the potential of electronic clinical data or CER, each of the projects is blending data streams from a variety of institutions and data types including administrative, clinical, and patient-reported data. These data will develop a fuller picture of patient experience that can be used to inform research and quality improvement efforts. Collaboration among Federal agencies; organizations at the Federal, state and local levels; and between the public and private sectors is also critical.7 As a result, all of the projects are investing in multi-institution partnerships and developing transdisciplinary teams to ensure sustainable infrastructure and processes are in place to allow “data to flow” for research, QI, and clinical decision support.
The projects represent a range of partnership models and geographic scope, and vary substantially in size. Some are national networks, whereas others are more locally focused. Two of the 11 projects are state-specific (Washington and Indiana) and 1 project focuses locally on a specific community in New York City. Overall, 20 states are represented. The networks also range in size from 11,000 to 7.5 million individuals. The estimates of network size that are included in this report reflect the number of patients with specific priority populations and conditions who would be eligible to participate in the CER studies conducted by the projects. In a few cases, the size of the full network is much larger, specifically with respect to the projects that are affiliated with the HMO Research Network (HMORN). In total, the number of patients included in the HMORN is estimated to include more than 18 million patients. Figure 1 represents the geographic scope of all the 11 projects participating in the EDM Forum.
In addition to building infrastructure for large, networked studies, each of the projects includes a set of specific research studies to demonstrate proof of concept for using electronic clinical data for CER and PCOR. Thirty-eight such CER studies are planned or underway on a range of populations and topics. As a whole, the studies address nearly all of the AHRQ priority populations and conditions, with several projects focused on low-income populations, racial and ethnic minorities, and topical areas such as hypertension and asthma. Table 2 provides a summary of the number of studies addressing specific priority populations and conditions. The studies are also conducting CER for a range of treatments and interventions, diagnosis and adherence measures, care management strategies, care delivery characteristics, and quality of life measures. Patient-reported outcomes are being collected and analyzed in most of the projects.
Building infrastructure to conduct CER and PCOR using electronic clinical data has been a growing enterprise for more than a decade. The following list of projects encompasses major efforts to build research infrastructure with electronic health data: Clinical and Translational Science Awards (CTSA),8–11 including workgroups, systems, and tools developed through the CTSA; Health Maintenance Organization Research Network12; Distributed Ambulatory Research in Therapeutics Network13; Food and Drug Administration (FDA) Sentinel System14; FDA Partnership in Applied Comparative Effectiveness Science15; FDA Janus Clinical Trial Data Repository16; Observational Medical Outcomes Partnership17; Office of the National Coordinator Beacon Community Program18; Veterans Affairs Informatics and Computing Infrastructure19; Strategic Health IT Advanced Research Projects Program20; QueryHealth21; and The Shared Health Research Information Network.22
The EDM Forum’s efforts with the PROSPECT, DRN, Enhanced Registry projects share a common goal with many of these initiatives—to generate evidence and build a learning health care system that can improve patient outcomes. A critical aspect of this charge is identifying lessons learned from relevant initiatives to advance the national dialog on the use of electronic clinical data for the conduct of CER, QI, and clinical decision support. The EDM Forum supports these efforts by fostering exchange of information on promising practices, and identifying opportunities for collaboration across the research project teams, related activities, and key stakeholders across a variety of organizations and agencies.
1. US Department of Health and Human Services. Text of the Recovery Act Related to Comparative Effectiveness Funding. Excerpt from the American Recovery and Reinvestment Act of 2009. [HHS Recovery Act web site]. 2009. Available at: http://www.hhs.gov/recovery/programs/cer/recoveryacttext.html
. Accessed August 31, 2011
3. Agency for Healthcare Research and Quality. ARRA-AHRQ Recovery Act 2009 Limited Competition: PROSPECT Studies: Building New Clinical Infrastructure for Comparative Effectiveness Research (R01). [PROSPECT Funding Opportunity Announcement web site]. 2009. Available at: http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-10-005.html
. Accessed November 1, 2011
4. Agency for Healthcare Research and Quality. ARRA OS Recovery Act 2009 Limited Competition: Enhanced Registries for Quality Improvement and Comparative Effectiveness Research (R01) [Enhanced Registries Funding Opportunity Announcement web site]. 2010. Available at: http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-10-020.html
. Accessed November 1, 2011
5. Agency for Healthcare Research and Quality. ARRA OS: Recovery Act 2009 Limited Competition: Scalable Distributed Research Networks for Comparative Effectiveness Research (R01). [Scalable Distributed Research Networks Funding Opportunity Announcement web site]. 2010. Available at: http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-10-015.html
. Accessed November 1, 2011
7. Federal Coordinating Council for Comparative Effectiveness Research. Report to the President and The Congress: US Department of Health and Human Services; June 2009
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11. Payne P, Ervin D, Dhaval R, et al. TRIAD: The Translational Research Informatics and Data Management Grid. Appl Clin Inform. 2011;2:331–344
12. Collaboration Toolkit: A Guide to Multicenter Research in the HMO Research Network. 2011:16–20
13. Pace W, West D, Valuck R, et al. Distributed Ambulatory Research in Therapeutics Network (DARTNet): Summary Report. 2009 Rockville, MD Agency for Healthcare Research and Quality
17. Foundation for the National Institutes of Health. Observational Medical Outcomes Partnership. [OMOP web site]. 2011. Available at: http://omop.fnih.org
. Accessed February 22, 2012
18. Maxson ER, Jain SH, McKethan AN, et al. Beacon communities aim to use health information technology to transform the delivery of care. Health Aff (Millwood). 2010;29:1671–1677
22. Weber GM, Murphy SN, McMurry AJ, et al. The Shared Health Research Information Network (SHRINE): a prototype federated query tool for clinical data repositories. J Am Med Inform Assoc. 2009;16:624–630