Rapid identification of myocardial infarction risk associated with diabetes medications using electronic medical records.

OBJECTIVE To assess the ability to identify potential association(s) of diabetes medications with myocardial infarction using usual care clinical data obtained from the electronic medical record. RESEARCH DESIGN AND METHODS We defined a retrospective cohort of patients (n = 34,253) treated with a sulfonylurea, metformin, rosiglitazone, or pioglitazone in a single academic health care network. All patients were aged >18 years with at least one prescription for one of the medications between 1 January 2000 and 31 December 2006. The study outcome was acute myocardial infarction requiring hospitalization. We used a cumulative temporal approach to ascertain the calendar date for earliest identifiable risk associated with rosiglitazone compared with that for other therapies. RESULTS Sulfonylurea, metformin, rosiglitazone, or pioglitazone therapy was prescribed for 11,200, 12,490, 1,879, and 806 patients, respectively. A total of 1,343 myocardial infarctions were identified. After adjustment for potential myocardial infarction risk factors, the relative risk for myocardial infarction with rosiglitazone was 1.3 (95% CI 1.1-1.6) compared with sulfonylurea, 2.2 (1.6-3.1) compared with metformin, and 2.2 (1.5-3.4) compared with pioglitazone. Prospective surveillance using these data would have identified increased risk for myocardial infarction with rosiglitazone compared with metformin within 18 months of its introduction with a risk ratio of 2.1 (95% CI 1.2-3.8). CONCLUSIONS Our results are consistent with a relative adverse cardiovascular risk profile for rosiglitazone. Our use of usual care electronic data sources from a large hospital network represents an innovative approach to rapid safety signal detection that may enable more effective postmarketing drug surveillance.

STROBE-based methodology for detection of adverse events across multiple communities.

Partners Healthcare is one of five institutions in conjunction with eHealth Initiative (eHI) and the FDA that is collaborating in a nation-wide effort to develop novel health information technology tools to create an active drug safety surveillance system across the U.S. The STROBE statement serves as the standard for the definition of a structured, systematic, reproducible approach for detecting both the risks and benefits of drug treatments in multiple settings.

Knowledge management and content integration: a collaborative approach.

Knowledge Management (KM) is the development and maintenance of decision support knowledge within clinical healthcare systems. At Partners Healthcare System (PHS), Knowledge Management is facilitated by a dedicated team consisting of Subject Matter Experts (SME), Knowledge Engineers (KE), and software developers. This group relies upon sound knowledge management principles to support the knowledge lifecycle.

Design and implementation of a clinical rule editor for chronic disease reminders in an electronic medical record.

Clinical reminders have well-documented benefits in improving quality of care. Once clinicians approve evidence-based rules, they should be quickly implemented. However, most of the reminders in our home-grown EMR historically were hard-coded, making it difficult to maintain old rules and implement new ones. We designed a web-based editor to make rule logic readable and editable by non-programmers. We hope to decrease the turnaround time of reminder authoring and maintenance, thereby improving quality of care.