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Harnessing EHR Data for Population Health Surveillance: Constructing the NYC Macroscope
The federal government has invested $19.2 billion in the adoption and meaningful use of electronic health records (EHRs), fueling the creation of large streams of health outcome data. These data have the potential to drive public health, if captured and analyzed effectively. New York City is using EHR data to build the NYC Macroscope, a population health surveillance system covering major areas of morbidity, especially chronic disease.
Objective
Describe the creation of a population surveillance system using electronic health record data from ambulatory practices in New York City
Methods
From 2012 to 2013, the NYC Department of Health and the CUNY School of Public Health defined key EHR-based indicators that could be validated against a gold standard examination survey. After reviewing the EHR surveillance literature, we designed indicators to reflect population health priority areas that are routinely documented in EHRs and reinforced by meaningful use. A scientific advisory committee convened quarterly to assess finalized indicators and protocols.
Results
We retained indicators covering hypertension, diabetes, cholesterol, obesity, smoking, influenza and depression. We added age, gender and neighborhood poverty stratifications for population weighting. Patient level inclusion criteria were adults age 20+ with a NYC zip code and a visit in the reporting year. Provider level inclusion criteria required routine documentation of medications, diagnoses and vitals; and a primary care specialty. Indicators were translated into SQL code queries and tested in partner EHR systems. A total of 649 practices returned data for the 2012 NYC Macroscope indicators.
Discussion
New York City is building the first municipal EHR-based surveillance system in the country. As EHR adoption spreads, other jurisdictions may increasingly gain access to this valuable data but lack the expertise to adapt it for public health. We hope to provide a blueprint for integrating healthcare data into population health surveillance activities.
Learning Areas:
Clinical medicine applied in public healthCommunication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Public health or related research
Learning Objectives:
Describe how electronic health record data can be adapted to support population surveillance
Keyword(s): Surveillance, Information Technology
Qualified on the content I am responsible for because: I am currently the Senior Epidemiologist at the Primary Care Information Project, where I oversee surveillance and population monitoring using the Hub Population Health System, an ad-hoc query network which allows us to collect data from 651 ambulatory practices in New York City.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.