National Network Leverages Electronic Health Records to Improve Care

A research group led by The Children’s Hospital of Philadelphia’s Alexander G. Fiks, MD, MSCE, details the creation of a national “super network” devoted to comparative effectiveness research (CER) based on electronic health record clinical data, in a special article published in Pediatrics. The network — the Comparative Effectiveness Research Through Collaborative Electronic Reporting Consortium (CER²) — comprises 222 sites across 27 states and 2,119 practitioners. CER² investigators are currently using electronic health record data from more than 1.2 million pediatric patients to conduct long-term pharmacology-related CER.

CER² was established in 2012 with funding from the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, as well as the Health Resources and Services Administration’s Maternal and Child Health Bureau.

By leveraging electronic health records, the consortium has been working to “broadly improve child healthcare,” the Pediatrics authors note. Because it is comprised of seven networks — from CHOP’s Pediatric Research Consortium, to the American Academy of Pediatrics’ Pediatric Research in Office Settings, to the Ohio-based MetroHealth system, to Indiana’s Eskenazi Health — CER² reflects a broad range of populations and healthcare settings.

“It has been estimated repeatedly over the past 40 years that 75 to 80 percent of pharmaceuticals possess insufficient labeling information for dosing, safety, or efficacy in children,” the authors note in the Pediatrics article.

“To address these knowledge gaps, large EHR databases” — such as those offered by CER² — “from diverse practice settings are particularly helpful resources because they can link prescribing data with clinical outcomes, can identify cohorts of children for more detailed study, and can drive decision support to improve care based on medical evidence.”

Building upon this focus, CER² investigators are examining the treatment of hypertension, which the authors note affects between 2 and 4 percent of children, but “often remains undiagnosed.” Ultimately, the consortium seeks to improve the recognition and treatment of pediatric hypertension by using electronic health record tools to automatically alert physicians.

“The goal of CER² is to engage scholars from around the country in a diverse range of research projects focused on pediatric medication, safety, and effectiveness, as well as other areas including preventative care, treatment of acute conditions, and chronic disease management,” the authors wrote.

In addition to Dr. Fiks, Children’s Hospital’s Robert Grundmeier, MD, of the Department of Biomedical and Health Informatics; Jennifer Steffes of the American Academy of Pediatrics; David Kaelber, MD, of Case Western Reserve University, Cleveland; Wilson Pace, MD, of the American Academy of Family Physicians National Research Network; William G. Adams, MD, of Boston University; and Richard Wasserman, MD, of the University of Vermont, contributed to the article.

To read more about the CER² Consortium, see the organization’s web page or read the recent Pediatrics study.