Adjusting for the progressive digitization of health records: working examples on a multi-hospital clinical data warehouse

Objectives To propose a new method to account for time-dependent data missingness caused by the increasing digitization of health records in the analysis of large-scale clinical data. Materials and Methods Following a data-driven approach we modeled the progressive adoption of a common electronic health record in 38 hospitals. To this end, we analyzed data collected between 2013 and 2022 and made available in the clinical data warehouse of the Greater Paris University Hospitals. Depending on the category of data, we worked either at the hospital, department or unit level. We evaluated the performance of this model with a retrospective cohort study. We measured the temporal variations of some quality and epidemiological indicators by successively applying two methods, either a naive analysis or a novel complete-source-only analysis that accounts for digitization-induced missingness. Results Unrealistic temporal variations of quality and epidemiological indicators were observed when a naive analysis was performed, but this effect was either greatly reduced or disappeared when the complete-source-only method was applied. Discussion We demonstrated that a data-driven approach can be used to account for missingness induced by the progressive digitization of health records. This work focused on hospitalization, emergency department and intensive care units records, along with diagnostic codes, discharge prescriptions and consultation reports. Other data categories may require specific modeling of their associated data sources. Conclusions Electronic health records are constantly evolving and new methods should be developed to debias studies that use these unstable data sources. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study has been supported by grants from the AP-HP Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was reviewed and approved by the institutional review board of the AP-HP (IRB00011591, decision CSE21- 33). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes