Procurement of patient medical records from multiple health care facilities for public health research: feasibility, challenges, and lessons learned

Lay Summary This study evaluated the feasibility of a method for obtaining patient medical records from multiple health care facilities (HCFs). This method is especially beneficial when a single HCF or system does not fully represent the group of people being studied or when the research is designed to include factors related to the HCFs themselves. The research was conducted within the context of a study on HIV prevention among 460 patients receiving care from 122 HCFs. After obtaining voluntary authorization from participants, medical records were obtained and analyzed. The response rate was 89%, with 343 medical records obtained. However, the process was time-consuming, and less than 20% of the received medical records were electronic. Health Information Exchanges (HIEs), which securely share patient electronic health information between hospitals, are not generally accessible for research purposes. Overall, the method was feasible but presented challenges, including some unattained records and relatively high costs. Recommendations for improving the method include creating a centralized database for tracking HCF requirements, implementing a proactive approach to authorization forms, and advocating for increased accessibility of HIE systems for research purposes. Researchers should carefully consider the potential benefits and drawbacks of obtaining medical records from multiple HCFs when designing their studies. Objectives Studies that combine medical record and primary data are typically conducted in a small number of health care facilities (HCFs) covering a limited catchment area; however, depending on the study objectives, validity may be improved by recruiting a more expansive sample of patients receiving care across multiple HCFs. We evaluate the feasibility of a novel protocol to obtain patient medical records from multiple HCFs using a broad representative sampling frame. Materials and Methods In a prospective cohort study on HIV pre-exposure prophylaxis utilization, primary data were collected from a representative sample of community-dwelling participants; voluntary authorization was obtained to access participants' medical records from the HCF at which they were receiving care. Medical record procurement procedures were documented for later analysis. Results The cohort consisted of 460 participants receiving care from 122 HCFs; 81 participants were lost to follow-up resulting in 379 requests for medical records submitted to HCFs, and a total of 343 medical records were obtained (91% response rate). Less than 20% of the medical records received were in electronic form. On average, the cost of medical record acquisition was $120 USD per medical record. Conclusions Obtaining medical record data on research participants receiving care across multiple HCFs was feasible, but time-consuming and resulted in appreciable missing data. Researchers combining primary data with medical record data should select a sampling and data collection approach that optimizes study validity while weighing the potential benefits (more representative sample; inclusion of HCF-level predictors) and drawbacks (cost, missing data) of obtaining medical records from multiple HCFs.