Advancing real-world evidence in integrative medicine: The bridge framework

A research team led by Dr. Sun Xin (孙鑫) and Prof. Tan Jing (谭婧) from the Clinical Epidemiology and Evidence-based Medicine Center, West China Hospital, Sichuan University, recently published an article titled “Best practice for developing integrative Chinese-Western medicine databases using electronic health records” in the World Journal of Integrated Traditional and Western Medicine (WJIM). The study presents a comprehensive methodological framework for building high-quality integrative Chinese-Western medicine (ICWM) databases using electronic health record (EHR) data from multiple medical institutions, detailing the full implementation process, core components, and practical applications.

Electronic health records have become a key source of real-world data (RWD), supporting the development of real-world studies (RWS) and generating real-world evidence (RWE). In the field of traditional Chinese medicine (TCM), EHRs are an especially valuable source of evidence grounded in real-world clinical practice. However, transforming heterogeneous multi-source RWD into reliable research-ready RWE requires rigorously constructed databases. This task is particularly challenging for ICWM research due to complex clinical scenarios, large volumes of unstructured information, and the lack of standardized data collection processes.

To address these challenges, the team developed BRIDGE—Best pRactice for developing Integrative Chinese–Western medicine Databases usinG Electronic health records—the first methodological framework specifically tailored for constructing ICWM databases based on EHR data. The framework outlines standardized procedures for database design, architecture, data extraction and linkage, data governance, verification, and quality evaluation. The study further demonstrates its practical value through an empirical example: building an ICWM-EHR database focused on women’s reproductive lifespan.

Using the BRIDGE framework, researchers established the largest ICWM-EHR database on women’s reproductive lifespan, drawing on regional EHR data from 2014–2023. By defining clear inclusion and exclusion criteria and linking multiple data sources through a unified patient identifier, the team—comprising clinical epidemiologists, statisticians, and AI experts—completed standardized data processing and developed a comprehensive variable dictionary.

The resulting database supports a wide range of clinical research questions related to women’s reproductive health. It integrates 10 years of longitudinal medical records from about 2.06 million gynecological patients, including over 100 million diagnostic, prescription, and laboratory data entries from 82 public hospitals (43 tertiary and 39 secondary). Notably, it contains approximately 880,000 Chinese medicine diagnostic records and 920,000 syndrome pattern records, covering more than 1,000 ICD-10 three-digit disease codes, 2,957 chemical drugs, 1,578 Chinese patent medicines, 853 herbs, and 161 biological products. The most common TCM diagnoses were female genital diseases (A09.02, n = 456,320) and skin diseases (A08.01, n = 189,045), while the most frequent syndrome patterns were Qi-related syndromes (B03.01, n = 393,289) and dampness-related syndromes (B02.05, n = 298,360).

As the first methodological framework dedicated to EHR-based ICWM database development, BRIDGE provides an important foundation for advancing research on treatment patterns, clinical effectiveness, and prognostic evaluation in integrative medicine. Its emphasis on standardization, transparency, and traceability helps ensure that ICWM databases can reliably support high-quality real-world evidence and promote the modernization of traditional Chinese medicine in clinical research.

The complete study is accessible Via DOI: 10.70976/j.2096-0964.WJIM-2025-0019

World Journal of Integrated traditional and western Medicine (English Version) (WJIM, CN 10-1354/R, ISSN 2096-0964) is a quarterly, English-language, peer-reviewed academic journal dedicated to advancing the integration of traditional Chinese and Western medicine. Established in 2015, the journal is supervised by the China Association for Science and Technology and is solely sponsored by the China Association of Chinese Medicine. The founding Editor-in-Chief was Professor Wu Yiling, Academician of the Chinese Academy of Engineering, with Professor Lu Zhizheng, a distinguished TCM Master, serving as the Honorary Editor-in-Chief. The current Editor-in-Chief is Professor Zhang Xiaoxiao.

WJIM aims to report original theoretical research, the development and application of novel technologies and methodologies, as well as breakthroughs in clinical scientific inquiries, to promote the international exchange of Chinese medicine and integrative medicine.

WJIM welcomes manuscripts from all over the world on all aspects of traditional Chinese medicine, Chinese materia medica, and integrated traditional Chinese and Western medicine. Article types include Perspective, Review, Research Article, and Case Reports etc.