Objective: The development of predictive models for clinical application requires the availability of electronic health record (EHR) data, which is complicated by patient privacy concerns. We showcase the "Model to Data" (MTD) approach as a new mechanism to make private clinical data available for the development of predictive models. Under this framework, we eliminate researchers' direct interaction with patient data by delivering containerized models to the EHR data.
Materials And Methods: We operationalize the MTD framework using the Synapse collaboration platform and an on-premises secure computing environment at the University of Washington hosting EHR data. Containerized mortality prediction models developed by a model developer, were delivered to the University of Washington via Synapse, where the models were trained and evaluated. Model performance metrics were returned to the model developer.
Results: The model developer was able to develop 3 mortality prediction models under the MTD framework using simple demographic features (area under the receiver-operating characteristic curve [AUROC], 0.693), demographics and 5 common chronic diseases (AUROC, 0.861), and the 1000 most common features from the EHR's condition/procedure/drug domains (AUROC, 0.921).
Discussion: We demonstrate the feasibility of the MTD framework to facilitate the development of predictive models on private EHR data, enabled by common data models and containerization software. We identify challenges that both the model developer and the health system information technology group encountered and propose future efforts to improve implementation.
Conclusions: The MTD framework lowers the barrier of access to EHR data and can accelerate the development and evaluation of clinical prediction models.
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http://dx.doi.org/10.1093/jamia/ocaa083 | DOI Listing |
J Psoriasis Psoriatic Arthritis
January 2025
Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
Background: Generalized pustular psoriasis (GPP) is a rare, chronic, often unpredictable, severe multisystemic autoinflammatory skin disease from which patients can experience flares, episodes of widespread eruptions of painful, sterile pustules often accompanied by systemic symptoms. The impact of GPP flares and underlying GPP severity on the healthcare resource utilization (HCRU) is not well characterized.
Objective: To quantify HCRU among US GPP patients by flare status and underlying severity.
Objective: Federated research networks, like Evolve to Next-Gen Accrual of patients to Clinical Trials (ENACT), aim to facilitate medical research by exchanging electronic health record (EHR) data. However, poor data quality can hinder this goal. While networks typically set guidelines and standards to address this problem, we developed an organically evolving, data-centric method using patient counts to identify data quality issues, applicable even to sites not yet in the network.
View Article and Find Full Text PDFThe COVID-19 pandemic has been associated with increased neuropsychiatric conditions in children and youths, with evidence suggesting that SARS-CoV-2 infection may contribute additional risks beyond pandemic stressors. This study aimed to assess the full spectrum of neuropsychiatric conditions in COVID-19 positive children (ages 5-12) and youths (ages 12-20) compared to a matched COVID-19 negative cohort, accounting for factors influencing infection risk. Using EHR data from 25 institutions in the RECOVER program, we conducted a retrospective analysis of 326,074 COVID-19 positive and 887,314 negative participants matched for risk factors and stratified by age.
View Article and Find Full Text PDFOtolaryngol Head Neck Surg
January 2025
Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Objective: Hearing loss (HL) is associated with depression, but existing datasets are limited by the type of data available for both hearing and mental health conditions. The purpose of this study is to determine if there is an association between HL and depressive disorders within a large bi-institutional electronic health record (EHR) system containing more granular diagnostic information.
Study Design: Cross-sectional epidemiologic study.
BMC Anesthesiol
January 2025
Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
Background: Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient's own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data.
Methods: Patients 65-years and older undergoing urgent or emergency non-cardiac surgery within 21 hospitals 2017-2021 were used to develop the model (randomly split: 80% training, 20% test).
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