Kaur, Nayanjot

ABSTRACT Objective The Minnesota Electronic Health Record Consortium (MNEHRC) was established during the early days of the COVID‐19 pandemic to provide data for public health surveillance from the eleven largest health care systems in Minnesota. Methods This is a descriptive study of the Consortium, which is a federated network that implements best practices for governance and data infrastructure to support public health surveillance and clinical research. We conducted an analysis of the Consortium members, governance structure, infrastructure, and the characteristics of the patient population. Results The Consortium health systems collect information from 105 hospitals, 773 clinics, 100 emergency departments and 29 040 providers. Information about the health systems and the demographic and clinical characteristics of its 5 471 367 patients is provided, which represents more than 90% of the patients in Minnesota. This manuscript also details the MNEHRC governance structure, working groups, data use agreements and technical infrastructure. The Consortium has produced several studies with state‐wide impact. One study, Health Trends Across Communities in Minnesota, is described in detail to illustrate aspects of this collaboration. Conclusion MNEHRC has been a successful collaboration and vital resource for public health surveillance in the state of Minnesota. Initially, the Consortium focused on surveillance related to COVID‐19 infections and vaccinations but has recently expanded into other public health and chronic disease research.

Key Points Identifying ways to prevent AKI may reduce mortality further in the setting of intensive BP control. Creatinine-based ascertainment of AKI, enabled by electronic health record data, may be more sensitive and less biased than traditional serious adverse event adjudication. Background Adjudication of inpatient AKI in the Systolic Blood Pressure Intervention Trial (SPRINT) was based on billing codes and admission and discharge notes. The purpose of this study was to evaluate the effect of intensive versus standard BP control on creatinine-based inpatient and outpatient AKI, and whether AKI was associated with cardiovascular disease (CVD) and mortality. Methods We linked electronic health record (EHR) data from 47 clinic sites with trial data to enable creatinine-based adjudication of AKI. Cox regression was used to evaluate the effect of intensive BP control on the incidence of AKI, and the relationship between incident AKI and CVD and all-cause mortality. Results A total of 3644 participants had linked EHR data. A greater number of inpatient AKI events were identified using EHR data (187 on intensive versus 155 on standard treatment) as compared with serious adverse event (SAE) adjudication in the trial (95 on intensive versus 61 on standard treatment). Intensive treatment increased risk for SPRINT-adjudicated inpatient AKI (HR, 1.51; 95% CI, 1.09 to 2.08) and for creatinine-based outpatient AKI (HR, 1.40; 95% CI, 1.15 to 1.70), but not for creatinine-based inpatient AKI (HR, 1.20; 95% CI, 0.97 to 1.48). Irrespective of the definition (SAE or creatinine based), AKI was associated with increased risk for all-cause mortality, but only creatinine-based inpatient AKI was associated with increased risk for CVD. Conclusions Creatinine-based ascertainment of AKI, enabled by EHR data, may be more sensitive and less biased than traditional SAE adjudication. Identifying ways to prevent AKI may reduce mortality further in the setting of intensive BP control.