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      Gathering data for decisions: best practice use of primary care electronic records for research

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          Summary

          • In Australia, there is limited use of primary health care data for research and for data linkage between health care settings. This puts Australia behind many developed countries. In addition, without use of primary health care data for research, knowledge about patients’ journeys through the health care system is limited.

          • There is growing momentum to establish “big data” repositories of primary care clinical data to enable data linkage, primary care and population health research, and quality assurance activities. However, little research has been conducted on the general public's and practitioners’ concerns about secondary use of electronic health records in Australia.

          • International studies have identified barriers to use of general practice patient records for research. These include legal, technical, ethical, social and resource‐related issues. Examples include concerns about privacy protection, data security, data custodians and the motives for collecting data, as well as a lack of incentives for general practitioners to share data.

          • Addressing barriers may help define good practices for appropriate use of health data for research. Any model for general practice data sharing for research should be underpinned by transparency and a strong legal, ethical, governance and data security framework.

          • Mechanisms to collect electronic medical records in ethical, secure and privacy‐controlled ways are available.

          • Before the potential benefits of health‐related data research can be realised, Australians should be well informed of the risks and benefits so that the necessary social licence can be generated to support such endeavours.

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          Most cited references15

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          Big data analytics in healthcare: promise and potential

          Objective To describe the promise and potential of big data analytics in healthcare. Methods The paper describes the nascent field of big data analytics in healthcare, discusses the benefits, outlines an architectural framework and methodology, describes examples reported in the literature, briefly discusses the challenges, and offers conclusions. Results The paper provides a broad overview of big data analytics for healthcare researchers and practitioners. Conclusions Big data analytics in healthcare is evolving into a promising field for providing insight from very large data sets and improving outcomes while reducing costs. Its potential is great; however there remain challenges to overcome.
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            Patient Perspectives on Sharing Anonymized Personal Health Data Using a Digital System for Dynamic Consent and Research Feedback: A Qualitative Study

            Background Electronic health records are widely acknowledged to provide an important opportunity to anonymize patient-level health care data and collate across populations to support research. Nonetheless, in the wake of public and policy concerns about security and inappropriate use of data, conventional approaches toward data governance may no longer be sufficient to respect and protect individual privacy. One proposed solution to improve transparency and public trust is known as Dynamic Consent, which uses information technology to facilitate a more explicit and accessible opportunity to opt out. In this case, patients can tailor preferences about whom they share their data with and can change their preferences reliably at any time. Furthermore, electronic systems provide opportunities for informing patients about data recipients and the results of research to which their data have contributed. Objective To explore patient perspectives on the use of anonymized health care data for research purposes. To evaluate patient perceptions of a Dynamic Consent model and electronic system to enable and implement ongoing communication and collaboration between patients and researchers. Methods A total of 26 qualitative interviews and three focus groups were conducted that included a video presentation explaining the reuse of anonymized electronic patient records for research. Slides and tablet devices were used to introduce the Dynamic Consent system for discussion. A total of 35 patients with chronic rheumatic disease with varying levels of illness and social deprivation were recruited from a rheumatology outpatient clinic; 5 participants were recruited from a patient and public involvement health research network. Results Patients were supportive of sharing their anonymized electronic patient record for research, but noted a lack of transparency and awareness around the use of data, making it difficult to secure public trust. While there were general concerns about detrimental consequences of data falling into the wrong hands, such as insurance companies, 39 out of 40 (98%) participants generally considered that the altruistic benefits of sharing health care data outweighed the risks. Views were mostly positive about the use of an electronic interface to enable greater control over consent choices, although some patients were happy to share their data without further engagement. Participants were particularly enthusiastic about the system as a means of enabling feedback regarding data recipients and associated research results, noting that this would improve trust and public engagement in research. This underlines the importance of patient and public involvement and engagement throughout the research process, including the reuse of anonymized health care data for research. More than half of patients found the touch screen interface easy to use, although a significant minority, especially those with limited access to technology, expressed some trepidation and felt they may need support to use the system. Conclusions Patients from a range of socioeconomic backgrounds viewed a digital system for Dynamic Consent positively, in particular, feedback about data recipients and research results. Implementation of a digital Dynamic Consent system would require careful interface design and would need to be located within a robust data infrastructure; it has the potential to improve trust and engagement in electronic medical record research.
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              The other side of the coin: Harm due to the non-use of health-related data

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                Author and article information

                Contributors
                dboyle@unimelb.edu.au
                Journal
                Med J Aust
                Med. J. Aust
                10.5694/(ISSN)1326-5377
                MJA2
                The Medical Journal of Australia
                John Wiley and Sons Inc. (Hoboken )
                0025-729X
                1326-5377
                30 March 2019
                April 2019
                : 210
                : Suppl Suppl 6 ( doiID: 10.5694/mja2.v210.S6 )
                : S12-S16
                Affiliations
                [ 1 ] Department of General Practice University of Melbourne Melbourne VIC
                [ 2 ] Health and Biomedical Informatics Centre University of Melbourne Melbourne VIC
                [ 3 ] Melbourne Law School University of Melbourne Melbourne VIC
                [ 4 ] School of Population and Global Health University of Melbourne Melbourne VIC
                [ 5 ] Networked Society Institute University of Melbourne Melbourne VIC
                Author notes
                Article
                MJA250026
                10.5694/mja2.50026
                6487848
                30927466
                2fdd22db-9689-4f06-889a-584afce9144a
                © 2019 The Authors. Medical Journal of Australia published by AMPCo Pty Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 0, Tables: 0, Pages: 5, Words: 4529
                Funding
                Funded by: NHMRC
                Award ID: 1136117
                Categories
                Environment and Public Health
                General Medicine – Primary Care
                Health Occupations
                Health Services Administration
                Information Science
                Statistics, Epidemiology and Research Design
                Ethics and Law
                Expanding the Evidence Base in Digital Health
                Expanding the Evidence Base in Digital Health
                Custom metadata
                2.0
                mja250026
                April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:29.04.2019

                population health,general practice,health services research,data collection,technology,evidence‐based medicine,ethics, research,datasets as topic

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