Large-scale electronic health record research introduces biases compared to traditional manually curated retrospective research. We used data from a community-acquired pneumonia study for which we had a gold standard to illustrate such biases. The challenges include data inaccuracy, incompleteness, and complexity, and they can produce in distorted results. We found that a naïve approach approximated the gold standard, but errors on a minority of cases shifted mortality substantially. Manual review revealed errors in both selecting and characterizing the cohort, and narrowing the cohort improved the result. Nevertheless, a significantly narrowed cohort might contain its own biases that would be difficult to estimate.
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Hripcsak, George; Knirsch, Charles; Zhou, Li; Wilcox, Adam; Melton, Genevieve, Journal of Biomedical Discovery and Collaboration, 6, 48-52, DOI: 10.5210/disco.v6i0.3581
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