IT-CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety

J Am Med Inform Assoc. 2017 Mar 1;24(2):323-330. doi: 10.1093/jamia/ocw132.


Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety.

Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases.

Material and methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement.

Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data.

Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research.

Keywords: Patient safety; adverse event; big data; clinical epidemiology; data analytics; medical informatics.

MeSH terms

  • Cross-Over Studies*
  • Databases, Factual
  • Electronic Health Records*
  • Epidemiologic Methods*
  • Hemorrhage / etiology
  • Humans
  • Patient Safety*
  • Risk
  • Software
  • Thromboembolism / etiology