Identifying Unmet Treatment Needs for Patients With Osteoporotic Fracture: Feasibility Study for an Electronic Clinical Surveillance System.
BACKGROUND
Traditional clinical surveillance relied on the results from clinical trials and observational studies of administrative databases. However, these studies not only required many valuable resources but also faced a very long time lag.


OBJECTIVE
This study aimed to illustrate a practical application of the National Taiwan University Hospital Clinical Surveillance System (NCSS) in the identification of patients with an osteoporotic fracture and to provide a high reusability infrastructure for longitudinal clinical data.


METHODS
The NCSS integrates electronic medical records in the National Taiwan University Hospital (NTUH) with a data warehouse and is equipped with a user-friendly interface. The NCSS was developed using professional insight from multidisciplinary experts, including clinical practitioners, epidemiologists, and biomedical engineers. The practical example identifying the unmet treatment needs for patients encountering major osteoporotic fractures described herein was mainly achieved by adopting the computerized workflow in the NCSS.


RESULTS
We developed the infrastructure of the NCSS, including an integrated data warehouse and an automatic surveillance workflow. By applying the NCSS, we efficiently identified 2193 patients who were newly diagnosed with a hip or vertebral fracture between 2010 and 2014 at NTUH. By adopting the filter function, we identified 1808 (1808/2193, 82.44%) patients who continued their follow-up at NTUH, and 464 (464/2193, 21.16%) patients who were prescribed anti-osteoporosis medications, within 3 and 12 months post the index date of their fracture, respectively.


CONCLUSIONS
The NCSS systems can integrate the workflow of cohort identification to accelerate the survey process of clinically relevant problems and provide decision support in the daily practice of clinical physicians, thereby making the benefit of evidence-based medicine a reality.
['Lin|Fong-Ci|FC|0000-0001-9031-7113', 'Wang|Chen-Yu|CY|0000-0003-0498-2438', 'Shang|Rung Ji|RJ|0000-0003-1088-4180', 'Hsiao|Fei-Yuan|FY|0000-0003-1660-9120', 'Lin|Mei-Shu|MS|0000-0002-1607-9337', 'Hung|Kuan-Yu|KY|0000-0003-3472-5512', 'Wang|Jui|J|0000-0003-4800-5276', 'Lin|Zhen-Fang|ZF|0000-0002-8575-2521', 'Lai|Feipei|F|0000-0001-7147-8122', 'Shen|Li-Jiuan|LJ|0000-0002-2854-3205', 'Huang|Chih-Fen|CF|0000-0003-1311-8828']
D000368:Aged D015331:Cohort Studies D016208:Databases, Factual D005240:Feasibility Studies D005260:Female D006801:Humans D008875:Middle Aged D010024:Osteoporosis D058866:Osteoporotic Fractures D062486:Public Health Surveillance D011795:Surveys and Questionnaires
osteoporotic fractures guideline adherence information systems pharmacovigilance public health surveillance