In Reply I agree with Dr Opmeer that an important barrier to the conduct of high-quality RCTs nested in the EHR will be the quality of the EHR itself. I specifically noted in the Viewpoint that this would arguably be the greatest challenge.
Opmeer focuses on lack of completeness, validity, and reliability of clinical data in the EHR. Even though I share his concerns, I would point out that these same threats already compromise all clinical research.
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