Table 7 Summary of challenges presented along with possible solutions
Challenge | Possible solution(s) |
|---|---|
Source-specific variability in data availability | • Cluster data sources based on relevant study variables and eliminate those with insufficient data. • Investigate possible temporal missingness patterns and evidence of MNAR data. • Potentially leverage relevant techniques such as multiple imputation and inverse probability weighting to handle remaining missing data. |
Unreconciled drug exposure intervals | • Aggregate contiguous drug exposure intervals into single drug eras. • Residual open-ended intervals may not allow for time-varying analysis and may only be suitable for analysis as point exposures. |
Absence of baseline medical history | • Perform a sensitivity analysis to understand the impact of EHR-continuity on the estimand. • Consider incorporating prognostic factors proximal to the outcome into the model. |
Limited availability of out-of-hospital mortality data | • Consider a sensitivity analysis on censoring time for discharged patients. • Employ competing risk analysis analysis with discharge and in-hospital mortality as competing risks. |
Previous medical history carried forward in EHR data | • Calculate the number of events recorded per day throughout the visit for an outcome of interest. • Determine if treatment preceded the outcome or if it is an artifact. |