McVeigh Katharine

EHRs are increasingly being adopted to improve quality of care in health care systems, but they also have potential to monitor health at the population level. There has been relatively little focus on using EHRs for population health surveillance beyond infectious diseases. Current tools to monitor population health (vital statistics, hospital discharge data, population health surveys) are useful but can be expensive, and may be slow to conduct or produce findings. Aggregated EHR-derived data have the potential to deliver cheaper and faster data, and have the capacity to provide information on earlier disease stages, thus increasing the likelihood of timely use. If EHR data can be validated, they can be used to augment existing surveillance methods, resulting in more strategic targeting of health resources and better data to guide and evaluate public health initiatives and policies. New York City (NYC) is currently developing a pilot public health surveillance program known as NYC Macroscope, the first domestic effort to aggregate EHR data from independent primary care practices into a surveillance tool. This EHR-based population health surveillance system will compile summarized data from ambulatory electronic health records to help city health officials monitor and respond to real-time data on conditions of public health importance.

Objective

To describe the potential benefits and challenges of using electronic health record data for population health surveillance, and what to consider when establishing an electronic health record (EHR) surveillance system (EHRSS).

As a part of the Zika Birth Defects Surveillance, a national effort coordinated by the Centers for Disease Control and Prevention (CDC), NYC is conducting enhanced surveillance of all births with defects included in the congenital Zika syndrome (CZS) phenotype among infants born in NYC beginning in 2016. The intent of the project is to provide background on the prevalence of these conditions, regardless of cause. The surveillance project builds on the New York State (NYS) Congenital Malformations Registry, a passive, mandatory reporting system that relies on reporting from hospitals and providers. For the Surveillance project, potential cases of Zika-related birth defects (ZBD) are identified by hospital and administrative data of birth records with one or more of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes associated with CZS.1 The list of included diagnostic codes was specified by the NYS registry following guidance established by CDC. Full medical record chart abstraction of the birth hospital visit of potential cases is then conducted applying further inclusion guidelines to identify ZBD cases. Recent reports of late presentation of birth defects consistent with CZS suggest that some cases are being missed due to identification and diagnosis of the condition after birth.2 As one component of a broader strategy to obtain a more accurate surveillance count, we seek to identify potential ZBD cases first diagnosed in the 6-month postpartum period using Medicaid claims data.

Objective:

To assess the use of Medicaid claims data to conduct surveillance for cases of Zika-related birth defects identified after birth among infants born in New York City (NYC).