Table_1_Mapping progress in intravascular catheter quality surveillance: An Australian case study of electronic medical record data linkage.DOCX

Background and significanceIntravascular (IV) catheters are the most invasive medical device in healthcare. Localized priority-setting related to IV catheter quality surveillance is a key objective of recent healthcare reform in Australia. We sought to determine the plausibility of using electronic health record (EHR) data for catheter surveillance by mapping currently available data across state-wide platforms. This work has identified barriers and facilitators to a state-wide EHR surveillance initiative.
Materials and methodsData variables were generated and mapped from routinely used EHR sources across Queensland, Australia through a systematic search of gray literature and expert consultation with clinical information specialists. EHR systems were eligible for inclusion if they collected data related to IV catheter insertion, care, or outcomes of hospitalized patients. Generated variables were mapped against international recommendations for IV catheter surveillance, with data linkage and data export capacity narratively summarized.
ResultsWe identified five EHR systems, namely, iEMR, MetaVision ICU®, Multiprac, RiskMan, and the Nephrology Registry. Systems were used across jurisdictions and hospital wards. Data linkage was not evident across systems. Extraction processes for catheter data were not standardized, lacking clear and reliable extraction techniques. In combination, EHR systems collected 43/50 international variables recommended for catheter surveillance, however, individual systems collected a median of 24/50 (IQR 22, 30) variables. We did not identify integrated clinical analytic systems (incorporating machine learning) to support clinical decision making or for risk stratification (e.g., catheter-related infection).
ConclusionCurrent data linkage across EHR systems limits the development of an IV catheter quality surveillance system to provide timely data related to catheter complications and harm. To facilitate reliable and timely surveillance of catheter outcomes using clinical informatics, substantial work is needed to overcome existing barriers and transform health surveillance.

背景与意义
血管内导管（Intravascular Catheter，IV）是医疗领域中侵入性最高的医用器械。针对血管内导管质量监测的本地化优先级设定，是澳大利亚近期医疗改革的核心目标之一。本研究通过梳理全州级平台当前可用的数据，旨在探讨利用电子健康记录（Electronic Health Record, EHR）数据开展导管监测的可行性。本研究明确了全州级EHR监测项目所面临的障碍与促进因素。

材料与方法
本研究通过对灰色文献开展系统检索，并与临床信息专家进行咨询，从澳大利亚昆士兰州各常规使用的EHR数据源中生成并映射数据变量。纳入标准为：可收集住院患者血管内导管置入、护理或转归相关数据的EHR系统。将生成的数据变量与国际血管内导管监测推荐标准进行映射，并对数据联动与数据导出能力进行叙述性总结。

结果
本研究共识别出5款EHR系统，分别为iEMR、MetaVision ICU®、Multiprac、RiskMan及肾脏病登记系统（Nephrology Registry）。这些系统在各辖区与医院病房中均有使用，但各系统间未实现数据联动。导管数据的提取流程未实现标准化，缺乏清晰可靠的提取技术。综合来看，所有EHR系统可收集国际推荐的50项导管监测变量中的43项，但单个系统的中位数收集量为24/50项（四分位距（Interquartile Range, IQR）22~30）。本研究未发现可支持临床决策或风险分层（如导管相关感染）的集成临床分析系统（含机器学习）。

结论
当前EHR系统间的数据联动限制了血管内导管质量监测系统的开发，无法及时提供导管并发症与相关损害相关的数据。若要借助临床信息学手段实现导管转归的可靠且及时的监测，需开展大量工作以克服现有障碍，推动医疗监测体系变革。