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.
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).