Research Data Extraction Request Form
This form should be used to request patient-level data extraction services. 

If you need prep-to-research aggregate counts or a quote to include in a grant proposal, please use our Quotes & Aggregate Counts form instead.

We encourage study teams to visit our website before submitting a research data extraction request. Our website provides information on CDW-R services, available data, data request form submission, and updated CDW-R hourly fee tiers.

Request Submission Checklist
All below information must be provided at the time of submission for a data extraction request to be finalized and added to the CDW-R work queue:

  • All data extraction request details as described in the form, including relevant ICD & CPT codes, data definitions, Epic form names, etc.
  • Approved IRB study information.
  • Funding information, including an account number to be used for CDW-R services. 
  • Documentation of any special approvals such as data sharing agreements or permission to use Community Health Center data.
For the most efficient data extraction request process, we encourage you to have all information ready before submitting a request. It is the study team's responsibility to provide CDW-R with this information.

If any information is missing at the time of request submission, your request will remain on hold and not enter the CDW-R work queue until missing details are provided to cdw@bmc.org. Study teams should plan for several weeks between a finalized CDW-R data extraction request and receipt of the data. Visit our website for current wait times.

Questions?
If you have questions about the request process or would like assistance with preparing your data extraction request, reach out to CDW-R by emailing the study H-number and your questions to cdw@bmc.org. 

Study Data Extraction Request Form
Use this form to request a data set, prospective recruitment list, or retrospective cohort identification. 

If you need prep-to-research aggregate counts or a quote to include in a grant proposal, please use our Quotes & Aggregate Counts form instead.

Study Information














CDW-R Data Request Information






Cohort Identification





Record Date Range: Enter the date range for the requested data. 
The range may be exact dates (March 1, 2018 - December 31, 2018) or may be a specified period of time pre/post study enrollment.

CDW-R can only pull data within the date range reflected in your study's INSPIR application.


Cohort size
  • If providing inclusion/exclusion criteria: What is the estimated cohort size that you expect CDW-R to identify using the provided inclusion and exclusion criteria?
  • If your study team will supply a list of enrolled patients/MRNs to CDW-R: How many unique patients will be provided to CDW-R?

Data Extraction


Data Fields: What data do you need from CDW-R? 
List all the data fields you want the CDW-R to extract and provide to you in the data set.
  • Include all relevant ICD-10 and/or CPT codes.
  • Fully spell out all medications, treatments, surgeries, and/or procedures (do not use acronyms).
  • Provide all form and order names as they appear in Epic.
  • List only the data fields you need the CDW-R to extract. Do not include any data that you will hand abstract via supplemental chart review nor data collected via primary collection methods. 
  • Requested data fields may also be uploaded as a Word document or Excel file below.
IRB approval requirements

CDW-R can provide only data covered by your study’s IRB approval. Listing a field on this request form does not establish IRB approval or guarantee that it is available for extraction.

Before submitting your request, review the HIPAA Compliance section of your study’s INSPIR application and confirm that:

  • All requested data fields are listed under “Please list all data variables that are needed from the medical record or attach the file containing the data variables.”

  • All requested HIPAA identifiers are selected and specified, as applicable, under “Does your research require access to any of the HIPAA identifiers?”

If either section does not cover the requested data, please contact your IRB analyst to determine whether an amendment is needed.


Attachments

Attachments: Upload the list of data fields and/or other relevant study documents.
  • Reference P.I. Name and Study H-# in file title.
  • DO NOT include any patient identifiers  
  • Excel and Word docs are preferable. Please avoid uploading PDF documents.
  • Select "Upload another file" to upload additional files.

Contact Information











The CDW-R requires mentors to be engaged in the trainee's data request process. Mentors should plan to attend the initial data request consultation with the trainee. 







Funding Information

The CDW-R charges an hourly fee for all projects beyond simple count requests. Please review the CDW-R Billing & Fees website to confirm the correct hourly rate tier and ensure accurate account information is provided for proper project quoting: CDW-R: Fees and Billing | Boston Medical Center






















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