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Taiwan’s National Health Insurance Research Database: past and future

Authors Hsieh CY, Su CC, Shao SC, Sung SF, Lin SJ, Kao Yang YH, Lai ECC

Received 28 November 2018

Accepted for publication 12 March 2019

Published 3 May 2019 Volume 2019:11 Pages 349—358


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Henrik Toft Sørensen

Cheng-Yang Hsieh,1,2 Chien-Chou Su,1 Shih-Chieh Shao,1,3 Sheng-Feng Sung,4,5 Swu-Jane Lin,6 Yea-Huei Kao Yang,1 Edward Chia-Cheng Lai1,7

1School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; 3Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan; 4Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 5Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan; 6Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 7Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan

Abstract: Taiwan’s National Health Insurance Research Database (NHIRD) exemplifies a population-level data source for generating real-world evidence to support clinical decisions and health care policy-making. Like with all claims databases, there have been some validity concerns of studies using the NHIRD, such as the accuracy of diagnosis codes and issues around unmeasured confounders. Endeavors to validate diagnosed codes or to develop methodologic approaches to address unmeasured confounders have largely increased the reliability of NHIRD studies. Recently, Taiwan’s Ministry of Health and Welfare (MOHW) established a Health and Welfare Data Center (HWDC), a data repository site that centralizes the NHIRD and about 70 other health-related databases for data management and analyses. To strengthen the protection of data privacy, investigators are required to conduct on-site analysis at an HWDC through remote connection to MOHW servers. Although the tight regulation of this on-site analysis has led to inconvenience for analysts and has increased time and costs required for research, the HWDC has created opportunities for enriched dimensions of study by linking across the NHIRD and other databases. In the near future, researchers will have greater opportunity to distill knowledge from the NHIRD linked to hospital-based electronic medical records databases containing unstructured patient-level information by using artificial intelligence techniques, including machine learning and natural language processes. We believe that NHIRD with multiple data sources could represent a powerful research engine with enriched dimensions and could serve as a guiding light for real-world evidence-based medicine in Taiwan.

Keywords: Health and Welfare Data Center of Taiwan, real-world data, big data analysis, validation, database cross-linkage

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