Partnerships With Health Plans to Link Data From Electronic Health Records to Claims for Research Using PCORnet®.

Area of Science:

• Health Services Research
• Biomedical Informatics
• Clinical Effectiveness Research

Background:

• Health plans and public payers possess extensive claims data from patient-provider transactions.
• Electronic health records (EHRs) contain vital clinical information, often supplemented by claims data for research.
• PCORnet (Patient-Centered Outcomes Research Network) is a national network designed to facilitate health research.

Purpose of the Study:

• To showcase how health plan partnerships within PCORnet Clinical Research Networks (CRNs) enhance comparative effectiveness research (CER).
• To describe the regulatory and technical infrastructure for linking clinical and claims data.
• To demonstrate the utility of linked data through research use cases relevant to payers.

Main Methods:

• Leveraging the PCORnet Common Data Model (CDM) to standardize clinical data from 78 partner health systems.
• Establishing health plan partnerships within PCORnet CRNs (REACHnet, PaTH, OneFlorida+).
• Developing transferable regulatory and technical infrastructures for data linkage.

Main Results:

• Demonstrated the capacity for CER using linked EHR and claims data through specific CRN partnerships.
• Outlined transferable infrastructures enabling efficient data linkage for research.
• Presented use cases in weight-related outcomes and diabetes management.

Conclusions:

• Linking clinical EHR data with health insurance claims data significantly enhances the potential for CER.
• Established infrastructures and partnerships facilitate robust health research using integrated data sources.
• This integrated data approach aligns with payer interests in chronic disease management and patient outcomes.