Creating ethnicity-specific reference intervals for lab tests from EHR data

The results of clinical lab tests are an essential component of medical decision-making. To guide interpretation, test results are returned with reference intervals defined by the range in which 95% of values occur in healthy individuals. Clinical laboratories often set their own reference intervals to accommodate local population and instruments variations. This approach is costly and can be biased. We describe a novel data-driven method for using electronic health record data to extract healthy patients9 information to define reference intervals. We found that the distributions of many clinical lab tests differ among self-identified racial and ethnic groups (SIREs) in healthy patients. Finally, we derived SIRE-specific reference intervals and provide evidence that these intervals have clinical prognostic value. Specifically, we show that for two lab tests, serum creatinine level and hemoglobin A1C, SIRE-specific reference intervals are more predictive for need for dialysis and development type 2 diabetes than existing reference intervals.