Early online releases from Annals of Internal Medicine

High quality randomized clinical trials are not available to guide the clinical use of many therapies, so clinicians must rely on observational research. The AHRQ recently funded the development of the Distributed Ambulatory Research in Therapeutics Network, or DARTNet, to improve observational comparative effectiveness research and examine outcomes associated with prescription medications and medical devices. DARTNet is a federated network of electronic health data from eight organizations, representing more than 500 clinicians and 400,000 patients. A federated network links geographically and organizationally separate databases so that a single query can return results from multiple databases while also maintaining patient privacy. In addition to facilitating queries among the standardized and federated databases, the DARTNet system can prompt clinicians to obtain specific information during a patient visit. This capability allows the research team to collect additional data beyond what clinicians might routinely document in electronic records. Thus, DARTNet is designed to make available better data to enable high quality observational studies evaluating and comparing the effectiveness of various therapies.

If implemented, a national distributed health data network could become an important tool in the effort to improve the quality of health care. A distributed health data network is a system that allows secure, remote analysis of different medical organization or health plan datasets. In this type of network, organizations retain physical control over their data and its uses, allowing them to avoid issues related to confidentiality, regulation, and proprietary interests. Data from a national distributed health data network would cover many millions of people, which would have implications for studies pertaining to comparative effectiveness, best practices, diffusion of medical technologies, and quality of care. According to the researchers, there are considerable advantages to building a common core network to support the needs of multiple users, such as the FDA’s planned Sentinel System, the AHRQ’s DARTNet, and others, rather than building individual networks for each of these uses. The similarities in data needs and uses, coupled with potential savings of time and effort, favor a single, multi-purpose network. In closing, the authors caution that credible governance and funding mechanisms would be critical to ensure the long-term sustainability of the network.