title: How the provenance of electronic health record data matters for research: a case example using system mapping.
abstract: BACKGROUND
  The use of electronic health records (EHRs) for research is proceeding rapidly, driven by computational power, analytical techniques, and policy. However, EHR-based research is limited by the complexity of EHR data and a lack of understanding about data provenance, meaning the context under which the data were collected. This paper presents system flow mapping as a method to help researchers more fully understand the provenance of their EHR data as it relates to local workflow. We provide two specific examples of how this method can improve data identification, documentation, and processing.
  
  
  BACKGROUND
  EHRs store clinical and administrative data, often in unstructured fields. Each clinical system has a unique and dynamic workflow, as well as an EHR customized for local use. The EHR customization may be influenced by a broader context such as documentation required for billing.
  
  
  METHODS
  We present a case study with two examples of using system flow mapping to characterize EHR data for a local colorectal cancer screening process.
  
  
  RESULTS
  System flow mapping demonstrated that information entered into the EHR during clinical practice required interpretation and transformation before it could be accurately applied to research. We illustrate how system flow mapping shaped our knowledge of the quality and completeness of data in two examples: (1) determining colonoscopy indication as recorded in the EHR, and (2) discovering a specific EHR form that captured family history.
  
  
  CONCLUSIONS
  Researchers who do not consider data provenance risk compiling data that are systematically incomplete or incorrect. For example, researchers who are not familiar with the clinical workflow under which data were entered might miss or misunderstand patient information or procedure and diagnostic codes.
  
  
  CONCLUSIONS
  Data provenance is a fundamental characteristic of research data from EHRs. Given the diversity of EHR platforms and system workflows, researchers need tools for evaluating and reporting data availability, quality, and transformations. Our case study illustrates how system mapping can inform researchers about the provenance of their data as it pertains to local workflows.
authors.affiliation: Group Health Research Institute.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Johnson
authors.affiliation: Group Health Research Institute.
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.affiliation: Group Health Research Institute.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fuller
authors.affiliation: Group Health Research Institute.
authors.forename: Danielle
authors.initials: D
authors.lastname: Olmstead
authors.affiliation: Group Health Research Institute.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
keywords: Context; Data Use and Quality; Health Information Technology
references.citation: BMJ. 2013 Feb 04;346:f725
references.pmid: 23381205
references.citation: Med Care. 2012 Jul;50 Suppl:S19-20
references.pmid: 22692253
references.citation: J Am Med Inform Assoc. 2013 Jan 1;20(1):122-4
references.pmid: 22940670
references.citation: Med Care. 2013 Aug;51(8 Suppl 3):S30-7
references.pmid: 23774517
references.citation: Health Aff (Millwood). 2013 Aug;32(8):1478-85
references.pmid: 23840052
references.citation: EGEMS (Wash DC). 2014 Mar 24;2(1):1049
references.pmid: 25848584
references.citation: J Biomed Inform. 2012 Aug;45(4):763-71
references.pmid: 22326800
references.citation: Med Care. 2012 Jul;50 Suppl:S21-9
references.pmid: 22692254
references.citation: Yearb Med Inform. 2013;8:13-9
references.pmid: 23974543
references.citation: Health Serv Res. 2010 Oct;45(5 Pt 2):1431-41
references.pmid: 20695911
references.citation: J Am Med Inform Assoc. 2013 Jan 1;20(1):144-51
references.pmid: 22733976
references.citation: J Am Med Inform Assoc. 2013 Dec;20(e2):e226-31
references.pmid: 23956018
references.citation: J Am Med Inform Assoc. 2012 Jan-Feb;19(1):54-60
references.pmid: 22037893
references.citation: Health Serv Res. 2010 Oct;45(5 Pt 2):1468-88
references.pmid: 21054367
references.citation: EGEMS (Wash DC). 2013 Oct 08;1(1):1018
references.pmid: 25848563
references.citation: J Am Board Fam Med. 2013 Sep-Oct;26(5):603-11
references.pmid: 24004712
references.citation: Med Care. 2012 Jul;50 Suppl:S38-48
references.pmid: 22692258
references.citation: J Am Med Inform Assoc. 2014 Feb;21(e1):e147-51
references.pmid: 24001517
references.citation: Health Aff (Millwood). 2013 Aug;32(8):1470-7
references.pmid: 23840050
references.citation: Ann Fam Med. 2013 Jan-Feb;11(1):14-9
references.pmid: 23319501