Challenges and Opportunities from the Field of EHR-Based Surveillance
The federal government has invested $19.2 billion in adoption and meaningful use of electronic health records (EHRs), unleashing reams of data that could augment chronic disease surveillance. The NYC Department of Health and the CUNY School of Public Health are investigating this potential by building and validating the NYC Macroscope, an EHR-based chronic disease surveillance system, and by bringing together practitioners in a “community of practice.”
Identify shared opportunities and challenges that public health practitioners have encountered while using EHR data for population health monitoring
On October 17, 2014, we convened a one-day symposium on population health surveillance with practitioners currently using EHR data to monitor chronic disease. Diverse organizations participated: local health departments (3), federal agencies (3), clinical data research networks (4), academic institutions (5), foundations (2), regional health IT extension centers (2) and healthcare delivery networks (2). Common opportunities and challenges and top priorities for the field were identified.
Getting buy-in and establishing strong governance are key to collaboration between public health and healthcare. Participants felt that the field needs “peer-to-peer champions to discuss various issues like transparency [and] trust” and suggested that public health might be “the honest broker” among competing institutions. Desired development areas include “use cases, case definitions, data standards, standardized methods, validation, comparability [and] generalizability,” which may be adapted from other big data fields. Practitioners should identify the best use for available data, or “fit for purpose.” Top priorities included sustainability (cited by 24%), followed by data quality (23%), methods/standards (19%), governance (12%) and buy-in/engagement (10%).
EHR data does not automatically flow to public health practitioners. Public health entities need to foster trust and build collaboration by offering expertise in population health analytics. Developing a community of practice to share innovations and lessons learned would benefit the field.
Learning Areas:Administration, management, leadership
Chronic disease management and prevention
Clinical medicine applied in public health
Public health or related research
Describe public health practitioner's top challenges and opportunities in incorporating electronic health record data into chronic disease surveillance activities.
Keyword(s): Surveillance, Community Health Assessment
Qualified on the content I am responsible for because: I run the New York City Department of Health's Hub Population Health System, designing studies which use data from 700+ outpatient participating practices. In this role, I am able to see both opportunities and common pitfalls in trying to get public health utility from clinical data.
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.