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Am J Epidemiol. 2019 May 1;188(5):851-861. doi: 10.1093/aje/kwy292.

Challenges and Opportunities for Using Big Health Care Data to Advance Medical Science and Public Health.

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Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington.


Methodological advancements in epidemiology, biostatistics, and data science have strengthened the research world's ability to use data captured from electronic health records (EHRs) to address pressing medical questions, but gaps remain. We describe methods investments that are needed to curate EHR data toward research quality and to integrate complementary data sources when EHR data alone are insufficient for research goals. We highlight new methods and directions for improving the integrity of medical evidence generated from pragmatic trials, observational studies, and predictive modeling. We also discuss needed methods contributions to further ease data sharing across multisite EHR data networks. Throughout, we identify opportunities for training and for bolstering collaboration among subject matter experts, methodologists, practicing clinicians, and health system leaders to help ensure that methods problems are identified and resulting advances are translated into mainstream research practice more quickly.


big data; data privacy; data quality; electronic health records; pragmatic clinical trials; predictive modeling; privacy-protecting analyses; retrospective cohort studies


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