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Electronic Health Records

Hospital acquired infections are a major cause of morbidity, mortality and increased resource utilization. CDC estimates that in the US alone, over 2 million patients are affected by nosocomial infections costing approximately $34.7 billion to $45 billion annually (1). The existing process of detection and reporting relies on time consuming manual processing of records and generation of alerts based on disparate definitions that are not comparable across institutions or even physicians.



Objective:

Our objective was to conduct surveillance of nosocomial infections directly from multiple EMR data streams in a large multi-location Canadian health care facility. The system developed automatically triggers bed-day-level-location-aware reports and detects and tracks the incidents of nosocomial infections in hospital by ward.

Submitted by Magou on

Using the National Cancer Institute’s 2017 Health Information Trends Survey, the Office of the national Coordinator for Health Information Technology (ONC) reports on access and use of online medical records and the use of technology such as smartphones, tablets, and electronic monitoring devices (e.g. Fitbits, blood pressure monitors) for health related needs.

Submitted by ctong on

Medical claims and EHR data sources offer the potential to ascertain disease and health risk behavior prevalence and incidence, evaluate the use of clinical services, and monitor changes related to public health interventions. Passage of the HITECH Act of 2009 supports the availability of standardized EHR data for use by public health officials to obtain actionable information. While full adoption of EHRs is still years away, there are presently publicly- and commerciallyavailable EHR and medical claims data sets that could enhance public health surveillance at a national, regional and state level. The purposes of this evaluation were to i.) demonstrate the feasibility of gaining access to such data, ii.) evaluate their ability to augment current surveillance activities by developing measures for twenty separate healthcare indicators (e.g., HIV screening), iii.) evaluate each data source across a set of criteria needed for an effective surveillance system, and iv.) assess the ability of the data sources to evaluate changes in healthcare utilization and preventive services that may be a result of the 2009 Health Reform legislation.

Objective:

To assess the utility of inpatient and ambulatory clinical data compiled by public and commercial sources to enhance the Centers for Disease Control and Prevention’s surveillance activities.

 

Submitted by Magou on

Hypertension (HTN) is a highly prevalent chronic condition and strongly associated with morbidity and mortality. HTN is amenable to prevention and control through public and population health programs and policies. Therefore, public and population health programs require accurate, stable estimates of disease prevalence, and estimating HTN prevalence at the community-level is acutely important for timely detection, intervention, and effective evaluation. Current surveillance methods for HTN rely upon community-based surveys, such as the BRFSS. While BRFSS is the standard at the state- and national-level, they are expensive to collect, released once per year, and their confidence intervals are too wide for precise estimates at the local level. More timely, frequently updated, and locally precise prevalence estimates could greatly improve the timeliness and precision of public health interventions. The current study evaluated EHR data from a large, mature HIE as an alternative to community-based surveys for timely, accurate, and precise HTN prevalence estimation.

Objective:

To assess the equivalence of hypertension prevalence estimates between longitudinal electronic health record (EHR) data from a community-based health information exchange (HIE) and the Behavioral Risk Factor Surveillance System (BRFSS).

Submitted by elamb on

EpiCenter, NJ’s statewide syndromic surveillance system, collects ED registration data. The system uses chief complaint data to classify ED visits into syndrome categories and provides alerts to state and local health departments for surveillance anomalies. After the 2014 Ebola outbreak in West Africa, the New Jersey Department of Health (NJDOH) started collecting medical notes including triage notes, which contain more specific ED visit information than chief complaint, from 10 EDs to strengthen HAI syndromic surveillance efforts. In 2017, the NJDOH was aware of one NJ resident whose surgical site was infected following a cosmetic procedure outside of the US. This event triggered an intensive data mining using medical notes collected in EpiCenter. The NJDOH staff searched one week of medical notes data in EpiCenter with a specific keyword to identify additional potential cases of surgical-site infections (SSI) that could be associated with medical tourism.

Objective:

Medical notes provide a rich source of information that can be used as additional supporting information for healthcare-associated infection (HAI) investigations. The medical notes from 10 New Jersey (NJ) emergency departments (ED) were searched to identify cases of surgical-site infections (SSI).

Submitted by elamb on

Surveillance to track the incidence, prevalence and treatment of disease is a fundamental task of public health. The advent of universal health care coverage in the United States and electronic health records could make the medical record a valuable disease surveillance tool. This can only happen, however, if the necessary data can be extracted from the medical record without manual review.

Objective

The objective of this project was to identify criteria that accurately categorize acute coronary and heart failure events exclusively with electronic health record data so that the medical record can be used for surveillance without manual record review.

 

Submitted by Magou on

Practice Fusion is a web-based electronic health record system with over 150,000 medical professional users treating over 50 million patients. The company focuses on small, ambulatory practices and is predominately comprised of practices in the field of primary care. The user base makes it an ideal system for public health surveillance. The Research Division has undertaken pilot projects to demonstrate the viability of using the data for surveillance for acute diseases, like influenza-like illness, chronic diseases, like diabetes, and risk factors, like hypertension.

Objective

This showcase aims to demonstrate the viability of Practice Fusion’s web-based electronic health record system for national surveillance. Practice Fusion also wishes to provide aggregate data to public health departments for surveillance for free. This showcase also hopes to engage those potential partners around uses of the company’s research database.

 

Submitted by Magou on

Reports of infants born with congenital syphilis have increased in the United States every year since 2012. Prevention depends on high performing surveillance systems and compliance with the U.S. Centers for Disease Control and Prevention (CDC) recommendations to perform syphilis testing early in pregnancy, in the third trimester and at delivery if a woman is at high risk, and following a stillbirth delivery. These guidelines exist, because untreated syphilis is associated with adverse fetal outcomes including central nervous system infection and death. Surveillance of congenital syphilis and stillbirth is challenging because available data sources are limited. Assessment of compliance with testing guidelines is particularly challenging, since public health agencies often lack access to comprehensive cohorts of tested individuals as most public health laws only require reporting of positive disease case information.

Objective:

To measure stillbirth delivery rates and syphilis screening rates among women with a stillbirth delivery using electronic health record data available in a health information exchange.

Submitted by elamb on

Syndromic surveillance has been widely implemented for the collection of Emergency Department (ED) data. EDs may be the only option for seeking care in underserved areas, but they do not represent population-based measures. This analysis provides insight on health-seeking behaviors within the context of the type of care sought.

Objective:

To analyze differences in utilization of Emergency Departments for primary care sensitive conditions by facility and by patient ZIP code.

Submitted by elamb on

There is a saying in EMS that if you've "seen one EMS system, then you've seen one EMS system". Many EMS systems have good or even great data for surveillance and research, but while there are some standards developing for EMS data formats and sharing, very few systems have the capability to share data using them.Presenters discussed the current state of 9-1-1/EMS dispatch and field electronic medical records systems, and the changing impact of the official and informal standards and variations of data seen in different communities.

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