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Public Health IT

Public Health IT. Unit 7: Monitoring , Investigating, and Empowering Public Health with EHRs.

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Public Health IT

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  1. Public Health IT Unit 7: Monitoring, Investigating, and Empowering Public Health with EHRs This material (Comp13_Unit7a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003. This material was updated by Columbia University under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Lecture a

  2. Monitoring, Investigating, and Empowering with EHRs Learning Objectives • Objective 1: Describe the role of public health in context of clinical care environment • Objective 2: Identify and describe the following three essential public health services: • Monitor health • Diagnosis and investigate • Inform, educate, empower

  3. Monitoring, Investigating, and Empowering with EHRs Learning Objectives (Cont’d) • Objective 3: Identify public health practice challenges in these service areas • Objective 4: Identify opportunities for EHRs and HIEs to address these challenges in • Syndromic surveillance • Notifiable disease reporting • Public health case investigation • Objective 5: Describe challenges and limitations of EHRs to address these service areas

  4. Overview 7.1 Figure (Primary Care Information Project, 2010).

  5. Overview (Cont’d – 1) 7.2 Figure (Primary Care Information Project, 2010).

  6. 10 essential services 7.3 Figure (http://www.iom.edu/~/media/Files/Report Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Future of Publics Health 2002 Report Brief.pdf).

  7. Overview (Cont’d – 2) 7.4 Figure (Primary Care Information Project, 2010).

  8. Monitoring health 7.5 Figure (NYC Department of Health).

  9. Monitoring health (Cont’d – 1) • Provider reporting essential to monitoring communicable diseases • Providers have access to rich clinical and demographic information 7.6 Figure: (CDC, 2010).

  10. Barriers • Provider reporting not optimal, despite legal mandate • Lack of knowledge of reporting requirements • Time constraints • Limited resources available in small practices • Time constraints • Form completion, etc. • Lack of knowledge • Over 80 notifiable conditions

  11. Monitoring health (Cont’d – 2) • EHRs can support • Identification of cases for reporting • Diagnostic codes (ICD – 9 – CM; ICD – 10 – CM) • Lab results (LOINC) • Streamline reporting with pre – populated forms

  12. Pre – population • Utilize EHRs to pre – populate reporting forms • Allows providers to focus on remaining questions • Identifies the required fields for reporting • Reduces time required to complete form with is barrier to provider reporting 7.7 Figure (Wu, 2010).

  13. Overview (Cont’d – 3) 7.8 Figure (Primary Care Information Project, 2010).

  14. Syndromic surveillance • Track encounters meeting case definition • Chief complaint • Diagnosis • Other data • Report counts for trend analysis • Changes in trends investigated 7.9 Figure (Wu, 2010).

  15. Current challenges • Impact on provider workflow • Maintaining counts • Preparing reporting forms • Transmitting weekly

  16. Syndromicsurveillance (Cont’d – 2) • EHRs track encounters meeting case definition • Chief complaint • Diagnosis • Other data • Report counts for trend analysis

  17. Sample surveillance report 7.10 Figure (Wu, 2010).

  18. Overview (Cont’d – 4) 7.11 Figure (Primary Care Information Project, 2010).

  19. Diagnose and investigate health issues • RHIOs are organizations that support information exchange • Public health officials can access RHIO for disease case investigation purposes • Data may include demographics, laboratory values, medications

  20. Bronx RHIO 7.12 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  21. Overview (Cont’d – 5) 7.13 Figure (Primary Care Information Project, 2010).

  22. Translating PH information • Public health officials receive data from numerous sources • Notifiable disease reports • Syndromic surveillance • Environmental monitoring • These data are monitored and analyzed for abnormalities and potential threats • Alerts are then shared to notify health care providers and the public

  23. Examples of need for info exchange • Disease outbreaks • Medication or vaccine recalls • Environmental hazards • Improve access to essential public health services

  24. Current state of info exchange • Health Alert Network (HAN) • MMWR • Peer – reviewed literature • Mass media • Problem: information not into clinical workflow 7.14 Figure (E – coli alert, 2007).

  25. Current state – workflow 7.15 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  26. Integration of PH information via EHRs • Delivery of PH information by EHRs supports the following: • Information provided in the clinical workflow • Information provided in a contextually relevant manner • Collection of important patient history, ordering of essential diagnostic tests, and delivery of appropriate treatment via actionable order sets

  27. Measles alert • HAN alert issued for measles cluster February 25, 2008 • Institute for Family Health placed alert next day • Alert triggers: • CC of fever and rash • Alert triggered – 198 patients • Acknowledged – 4 patients (2%) 7.16 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  28. Legionella advisory • HAN advisory issued for increase in Legionella cases in Bronx July 24, 2007 • Institute for Family Health placed alert on July 27, 2007 • Alert triggers: • CC of fever • Cough • Chest pain • Chest congestion • Cold symptoms (Parckchester location only) • Alert triggered – 142 patients • Acknowledged – 5 patients (4%) 7.17 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  29. E. coli alert • HAN alert issued for E. coli O157 : H7 multistate outbreak September 28, 2007 • Institute for Family Health placed alert on October 1, 2007 • Alert triggers: • CC of diarrhea or stomach ache • Diagnosis of gastroenteritis • Diarrheas or bloody stool • Alert triggered – 287 patients • Acknowledged – 65 patients (23%) 7.18 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  30. Testing performed at visits 7.19 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  31. Future state – workflow 7.20 Figure (Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al., 2008).

  32. Limitations • Value added to clinical care • Alert fatigue • Making decision supports transportable • Standard vocabulary • Logic models • Order sets • Making more specific PH guidelines

  33. Monitoring, Investigating, and Empowering with EHRs – Lecture a, Summary • Public health practice incorporates three key areas: • Monitoring health • Investigating and diagnosing health problems • Informing, empowering, educating the public in how to respond to these health problems • PH practice often relies on clinical care to provide reporting and data necessary to monitor health and detect emerging problems • While PH practice often experiences resource limitations, they are expected to do more with less • PH enabled EHRs and HIE hold promise in facilitating PH practice as more clinical providers embrace these technologies

  34. Monitoring, Investigating, and Empowering with EHRs – Lecture a References References: HripcsakG, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic surveillance using ambulatory electronic health records. J Am Med Inform Assoc. 2009 May-Jun;16(3):354-61. Lazarus R, Klompas M, Campion FX, McNabb SJ, Hou X, Daniel J, Haney G, DeMaria A, LenertL, Platt R. Electronic Support for Public Health: validated case finding and reporting for notifiable diseases using electronic medical data. J Am Med Inform Assoc. 2009 Jan-Feb;16(1):18-24. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, CalmanN. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc. 2010 Mar 1;17(2): 217-9. Shapiro JS. Evaluating public health uses of health information exchange. J Biomed Inform. 2007 Dec;40(6 Suppl):S46-9.

  35. Monitoring, Investigating, and Empowering with EHRs References – Lecture a(Cont’d – 1) References: The future of public health. Ten Essential Services. (1988). Institute of Medicine report Retrieved on October 1st, 2010 fromhttp://www.iom.edu/~/media/Files/Report Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Future of Publics Health 2002 Report Brief.pdf Chart, Tables, Figures: 7.1 Figure: Primary Care Information Project, 2010. 7.2 Figure: Primary Care Information Project, 2010. 7.3 Figure: The future of public health. Ten Essential Services. (1988). Institute of Medicine report. Retrieved on October 1st, 2010 from http://www.iom.edu/~/media/Files/Report Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Future of Publics Health 2002 Report Brief.pdf. 7.4 Figure: Primary Care Information Project, 2010. 7.5 Figure: Retrieved October 1st, 2010 from NYC Department of Health.

  36. Monitoring, Investigating, and Empowering with EHRs References – Lecture a(Cont’d – 2) Chart, Tables and Figures: 7.6 Figure: Retrieved October 1st, 2010 from CDC. 7.7 Figure: Wu, W. (2010). Personal image of EHR- pre-population reporting. Primary Care Information Center, New York Department of Health and Mental Hygiene. 7.8 Figure: 7.9 Figure: Wu, W. (2010). Sample image of syndromic surveillance compares with WHO viral isolate data during a recent influenza season. Primary Care Information Center, New York Department of Health and Mental Hygiene. 7.10 Figure: Wu, W. (2010). Sample surveillance report. Primary Care Information Center, New York Department of Health and Mental Hygiene. 7.11 Figure: 7.12 Figure: Wu, W. (2010). Personal image of Bronx RHIO . Primary Care Information Center, New York Department of Health and Mental Hygiene. 7.13 Figure:

  37. Monitoring, Investigating, and Empowering with EHRs References – Lecture a(Cont’d – 3) Chart, Tables and Figures: 7.14 Figure: E-coli alert. (2007). New York City Department of Health and Mental Hygiene. 7.15 Figure: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation-Slide 5 at the International Society for Disease Surveillance Annual Conference. 7.16 – 7.18 Figures: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation at the International Society for Disease Surveillance Annual Conference. 7.19 Figure: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation-Slide 15 at the International Society for Disease Surveillance Annual Conference. 7.20 Figure: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation at the International Society for Disease Surveillance Annual Conference.

  38. Unit 7: Monitoring, Investigating, and Empowering Public Health with EHRs – Lecture a This material (Comp 13 Unit 7a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Columbia University under Award Number 90WT0005.

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