title: Using Electronic Health Records for Population Health Research: A Review of Methods and Applications.
abstract: The use and functionality of electronic health records (EHRs) have increased rapidly in the past decade. Although the primary purpose of EHRs is clinical, researchers have used them to conduct epidemiologic investigations, ranging from cross-sectional studies within a given hospital to longitudinal studies on geographically distributed patients. Herein, we describe EHRs, examine their use in population health research, and compare them with traditional epidemiologic methods. We describe diverse research applications that benefit from the large sample sizes and generalizable patient populations afforded by EHRs. These have included reevaluation of prior findings, a range of diseases and subgroups, environmental and social epidemiology, stigmatized conditions, predictive modeling, and evaluation of natural experiments. Although studies using primary data collection methods may have more reliable data and better population retention, EHR-based studies are less expensive and require less time to complete. Future EHR epidemiology with enhanced collection of social/behavior measures, linkage with vital records, and integration of emerging technologies such as personal sensing could improve clinical care and population health.
authors.affiliation: Robert Wood Johnson Foundation Health and Society Scholars Program at the University of California, San Francisco, and the University of California, Berkeley, Berkeley, California 94720-7360; joanacasey@berkeley.edu.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Casey
authors.affiliation: Departments of Environmental Health Sciences and Epidemiology, Bloomberg School of Public Health, and the Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205; email: bschwar1@jhu.edu.|Center for Health Research, Geisinger Health System, Danville, Pennsylvania 17822.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Schwartz
authors.affiliation: Research, Development and Dissemination, Sutter Health, Walnut Creek, California 94596; email: stewarwf@sutterhealth.org.
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
authors.affiliation: Center for Health and Community and the Department of Psychiatry, University of California, San Francisco, California 94118; email: nancy.adler@ucsf.edu.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
mesh_terms: D000367:Age Factors; D003625:Data Collection / Q000379:methods*; D019937:Diagnostic Techniques and Procedures; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004777:Environment; D015340:Epidemiologic Research Design; D015438:Health Behavior; D006801:Humans; D008962:Models, Theoretical; D015203:Reproducibility of Results; D012737:Sex Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D055986:Vital Signs
keywords: EHR; electronic health records; environmental epidemiology; geographic information systems; health determinants; social epidemiology