title: Feasibility of extracting data from electronic medical records for research: an international comparative study.
abstract: Electronic medical records (EMR) offer a major potential for secondary use of data for research which can improve the safety, quality and efficiency of healthcare. They also enable the measurement of disease burden at the population level. However, the extent to which this is feasible in different countries is not well known. This study aimed to: 1) assess information governance procedures for extracting data from EMR in 16 countries; and 2) explore the extent of EMR adoption and the quality and consistency of EMR data in 7 countries, using management of diabetes type 2 patients as an exemplar.
  
  
  
  We included 16 countries from Australia, Asia, the Middle East, and Europe to the Americas. We undertook a multi-method approach including both an online literature review and structured interviews with 59 stakeholders, including 25 physicians, 23 academics, 7 EMR providers, and 4 information commissioners. Data were analysed and synthesised thematically considering the most relevant issues.
  
  
  
  We found that procedures for information governance, levels of adoption and data quality varied across the countries studied. The required time and ease of obtaining approval also varies widely. While some countries seem ready for secondary uses of data from EMR, in other countries several barriers were found, including limited experience with using EMR data for research, lack of standard policies and procedures, bureaucracy, confidentiality, data security concerns, technical issues and costs.
  
  
  
  This is the first international comparative study to shed light on the feasibility of extracting EMR data across a number of countries. The study will inform future discussions and development of policies that aim to accelerate the adoption of EMR systems in high and middle income countries and seize the rich potential for secondary use of data arising from the use of EMR solutions.
authors.affiliation: Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Michelle Helena
authors.initials: MH
authors.lastname: van Velthoven
authors.affiliation: Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mastellos
authors.affiliation: Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: O'Donoghue
authors.affiliation: Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK. josip.car@imperial.ac.uk.|Lee Kong Chian School of Medicine, Imperial College & Nanyang Technological University, Singapore, Singapore. josip.car@imperial.ac.uk.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
mesh_terms: D000328:Adult; D057286:Electronic Health Records / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D006801:Humans; D016247:Information Storage and Retrieval / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*
keywords: Data collection [MeSH]; Electronic health records [MeSH]; Electronic medical records; Global health [MeSH]