EHR Audit Logs: A New Goldmine for Health Services Research?

Julia Adler-Milstein 1, Jason S Adelman 2, Ming Tai-Seale 3, Vimla L Patel 4, Chris Dymek 5

Affiliations

PMID: 31821887
DOI: 10.1016/j.jbi.2019.103343

Abstract

A byproduct of the transition to electronic health records (EHRs) is the associated observational data that capture EHR users' granular interactions with the medical record. Often referred to as audit log data or event log data, these datasets capture and timestamp user activity while they are logged in to the EHR. These data - alone and in combination with other datasets - offer a new source of insights, which cannot be gleaned from claims data or clinical data, to support health services research and those studying healthcare processes and outcomes. In this commentary, we seek to promote broader awareness of EHR audit log data and to stimulate their use in many contexts. We do so by describing EHR audit log data and offering a framework for their potential uses in quality domains (as defined by the National Academy of Medicine). The framework is illustrated with select examples in the safety and efficiency domains, along with their accompanying methodologies, which serve as a proof of concept. This article also discusses insights and challenges from working with EHR audit log data. Ensuring that researchers are aware of such data, and the new opportunities they offer, is one way to assure that our healthcare system benefits from the digital revolution.

Keywords: Audit log data; Clinical workflow; EHRs; Event log data; Health services research; Health system evaluation.