142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Feasibility of generating community health measures based on geospatially-enabled electronic health records

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Karen Frederickson Comer, MLA , The Polis Center, Indiana University, Indianapolis, IN
Marc Rosenman, MD , Indiana University School of Medicine, Indianapolis, IN
Joseph Gibson, MPH, PhD , Marion County Public Health Department, Indianapolis, IN
Brian Dixon, MPA, PhD, FHIMSS , The Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN

Using geographic information technology, location data stored in electronic health records (EHRs) may improve our ability to identify and examine disparities in health outcomes and enable public health interventions to be targeted to at-risk communities.   


Through a Robert Wood Johnson Foundation grant, Indiana University, the Regenstrief Institute, Polis Center, and Marion County Public Health Department aim to develop and validate community health measures at various geographic levels smaller than a county using geospatially-enabled electronic health records (EHRs).


A preliminary list of potential community measures was compiled using standardized HEDIS measures.  HEDIS measures are used by health care providers for performance measurement and typically are reported by institution not by geographic area.  The list of potential measures was appended with suggestions from local public health professionals.  Feasibility for use in the project was evaluated based on: 1) electronic capture and availability in EHRs, 2) disease prevalence (related to potential statistically stability), 3) highest degree of geographic granularity available; and 4) potential to represent population health based on proportion of health care providers (HCPs) contributing related data to the health information exchange (HIE).


Twenty-four potential community health measures were identified.  All fourteen of the proposed HEDIS-based measures and six of the ten additional measures requested by the public health department were deemed feasible.  All proposed measures met the criteria for geographic granularity, with geographic coordinates and block IDs available based on street address. The more limiting criteria were electronic capture and percentage of HCPs contributing related data.


The growing adoption of EHR systems and flow of clinical data into HIEs provide the opportunity to generate more actionable information for community health.  Further research is needed to determine how reliable, accurate, and ultimately useful secondary electronic data will be for the development and use of geographically granular community health measures.

Learning Areas:

Communication and informatics
Public health administration or related administration
Public health or related research

Learning Objectives:
List criteria for evaluating the feasibility of an EHR-based community health measure. Discuss geographic information requirements for identifying geographic sub-populations relevant to community health planning. Describe several limitations in applying EHR data to measure health disparities by geographic boundaries.

Keyword(s): Community Health Assessment, Geographic Information Systems (GIS)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a co-investigator and/or project director on multiple local and federally funded projects for the research and development of spatial information methods and tools for investigating the relationships between health and geography. Since 2001, I have been working to assist communities and the health sector to apply spatial information and community-based data to enhance their capacity for community health improvement.
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.