Analysis of electronic health records finds effective medicines quicker and cheaper than clinical trials

13 August 2014

Analysing electronic health records of large patient populations can efficiently select the right patients and identify the effectiveness of treatments with minimal impact on patients and reduce the need for expensive clinical trials.

A study published in Health Technology Assessment [1] chose 300 people with high risk of cardiovascular disease from patient populations of 23 GP practices and looked at the outcomes of the use of statins by analysing their electronic records.

A second part of the study involved 31 participants and looked at the use of antibiotics in those with chronic obstructive pulmonary disease — where people have difficulty breathing, primarily due to the narrowing of their airways.

Currently, when researchers want to investigate whether one treatment is better than another they need to organise lengthy and expensive trials that require heavy form filling by patients and GP’s, additional staff resource, regular attendance at appointments and can create artificial test environments that do not represent the reality of patient’s behaviour in regular day-to-day life.

For the purposes of this study, researchers instead installed special software in 23 approved GP surgeries across England and Scotland. This software was able to confidentially identify which patients were eligible to take part and allowed doctors to sign up relevant participants at the click of a button, saving time and money for the public purse.

Researchers then used data extracted from the qualifying patients’ electronic health records, as recorded in the Clinical Practice Research Datalink, updated as part of their regular medical appointments, to monitor the impact of the treatments they had been prescribed.

By studying these records, researchers were able to understand health outcomes of specific medications with potentially much larger and more diverse members of the public, and to determine which treatment gave the best results. The research was conducted with minimal impact on the lives of the patients who, after offering their consent for the use of their medical data were not required to have any active involvement.

Research leader Prof van Staa, then a member of the Clinical Practice Research Datalink (CPRD) and now based at The University of Manchester’s Health eResearch Centre, said, “The use of electronic health records in simplifying clinical trials means that we no longer need to remain uncertain about which medicine offers the best health benefits for patients. This study shows that scientists are able to conduct research which will highlight which treatment is best for patients.”

Following participation in the study, interviews took place with 27 GPs, 26 of whom expressed strong support for the use of patients’ electronic records to support clinical trial. Ten patients were also interviewed who all agreed that discussion of their involvement in the trial as part of a routine health appointment was a wholly acceptable practice.

Future studies regarding the use of electronic records in clinical trials will be delivered as part of the Farr Institute of Health Informatics. A national organisation that encompasses four centres of excellence in the field of eHealth research with Centres based in the North of England, East of England and Wales, Scotland and London.

The study was done in collaboration with researchers from the London school of Hygiene & Tropical Medicine and the Universities of York, Liverpool and Brighton and Kings’ College; it was funded by the National Institute for Health Research and the Wellcome Trust.

Reference

1. van Staa T-P. The opportunities and challenges of pragmatic point-of-care randomised trials using routinely collected electronic records: evaluations of two exemplar trials. Health Technology Assessment; Year: 2014, Volume: 18 Issue: 43.