International Consortium for Clinical Characterization of COVID-19 by EHR
The goal of this effort is to inform doctors, epidemiologists and the public about COVID-19 patients with data acquired through the health care process.  We are so grateful to have investigators participating in a variety of ways.

Ways to Get Involved

Attend our weekly Friday meetings and give input
Provide local clinical, informatics, or statistical expertise
Run 4CE analyses locally using EHR data at your institution
Start or Join a Working Group
International Sites Participating in 4CE Analyses

Ways to Run 4CE Analyses Within Your Institution

4CE is a federated network.  Sites run analyses locally and only share aggregate counts and statistics.  Patient-level data never leave your institution.

Phase 1.x
All sites running 4CE analyses

All sites choosing to run 4CE analyses must perform Phase 1.

  • Low regulatory barriers (please check local IRB/ethics regulations)
  • Run a 4CE SQL script on your database
  • Save results as aggregate-only files
  • Upload to central GitHub repo

Phase 1 studies have involved hundreds of hospitals and looked at topics such as temporal trends, COVID disease severity and long COVID.

Phase 2.x
Project-Specific Analysis

Phase 2 is optional, based on the time your interest and availability.

  • Select which working group(s) you’re interested in
  • Obtain any additional IRB approval(s)
  • Generate patient-level files that are saved locally and never shared
  • Run analyses in R packages on Docker
  • Undergo a rigorous QC process
  • Upload aggregate counts and statistics

Phase 2 studies focus on method development and specific diseases and conditions such as neurological sequelae, kidney injury, and long COVID.

Phase 1 and 2 studies are happening in parallel and the 4CE data model version number after the period (e.g. Phase X.2) refers to the data model used for those studies.

Please check with your working group(s) to make sure your version number matches any ongoing analyses you plan to contribute to.

Join a Working Group

Post-Acute Sequelae: The post-acute sequelae group seeks to model and explain the post-COVID syndrome by learning ‘long-hauler’ phenotypic predictors and understanding the risk factors contributing to specific symptoms. The acquired evidence will guide the potential strategies to mitigate this negative outcome.

Severity: Because actual measures of COVID severity are unavailable or unreliable in EHR data, we developed a proxy measure(phenotype) of severe COVID and validated it at 13 4CE sites and are now working to improve the severity phenotype via machine learning, hospital system dynamics, and new clinical measures.

AKI: The 4CE AKI group aims to examine critical trends and features in COVID-19kidney injury patients in hopes of finding comparative differences which might inform diagnosis and management of COVID-19 AKI patients.

Pediatrics: The main objective of the 4CEpediatric working group is to better understand the unique epidemiological and clinical features of pediatric COVID-19positive patients across distinct countries.

Thrombotic Events: The 4CEthromboti c working group aims to better understand thrombotic event burden, coagulation course, treatment efficacy, and health outcomes among COVID-19 patients.

Race-Ethnicity: This group will first utilize our international scale to report how the participating sites record race information into their respective EHR and how these classifications vary across countries, and then study the potential information loss occurring when harmonizing the site-specific race definition to the NIH Racial and Ethnic Categories standard.

Neurological: To fill the knowledge gaps pertaining to the burden of neurological diseases associated with SARS-CoV-2, the 4CEneurology group aims to:

  • Classify the phenotypes of nervous system involvement
  • Identify risk factors and prognostic indicators;
  • Map the natural trajectory and long-term course of the neurological complications
  • Generate hypotheses of potential treatments that would mitigate neurological involvement of SARS-CoV-2.


Link Directory
Our Publications
Contact Us
Office Hours every Friday to troubleshoot through specific problems. Please send us a message in Slack #qc-meeting if you plan to attend. We are also happy to schedule a separate time that works for your team.

4CE is supported by the i2b2 tranSMART Foundation, NIH award 3U01HG008685-05S2, and more than 100 volunteers across 8 countries.

i2b2 tranSMART Foundation Logo