CC BY 4.0 · ACI Open 2020; 04(01): e91-e101
DOI: 10.1055/s-0040-1713421
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Using Electronic Health Record Data to Support Research and Quality Improvement: Practical Guidance from a Qualitative Investigation

Richard C. Wasserman
1  Department of Pediatrics, Robert Larner MD College of Medicine, Burlington, Vermont, United States
Daria F. Ferro
2  Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
› Author Affiliations
Funding None.
Further Information

Publication History

22 March 2019

06 May 2020

Publication Date:
06 July 2020 (online)



Objective The aim of the study is to identify how academic health centers (AHCs) have established infrastructures to leverage electronic health record (EHR) data to support research and quality improvement (QI).

Methods Phone interviews of 18 clinical informaticians with expertise gained over three decades at 24 AHCs were transcribed for qualitative analysis on three levels. In Level I, investigators independently used NVivo software to code and identify themes expressed in the transcripts. In Level II, investigators reexamined coded transcripts and notes and contextualized themes in the learning health system paradigm. In Level III, an informant subsample validated and supplemented findings.

Results Level I analysis yielded six key “determinants”—Institutional Relationships, Resource Availability, Data Strategy, Response to Change, Leadership Support, and Degree of Mission Alignment—which, according to local context, affect use of EHR data for research and QI. Level II analysis contextualized these determinants in a practical frame of reference, yielding a model of learning health system maturation, over-arching key concepts, and self-assessment questions to guide AHC progress toward becoming a learning health system. Level III informants validated and supplemented findings.

Discussion Drawn from the collective knowledge of experienced informatics professionals, the findings and tools described offer practical support to help clinical informaticians leverage EHR data for research and QI in AHCs.

Conclusion The learning health system model builds on the tripartite AHC mission of research, education, and patient care. AHCs must deliberately transform into learning health systems to capitalize fully on EHR data as a staple of health learning.

Protection of Human and Animal Subjects

The University of Vermont and Children’s Hospital of Philadelphia Institutional Review Boards approved this study.