Electronic Health Records

The implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, permits health departments with the authority to establish programs to improve health care quality by the promotion of health IT and includes guidelines for receiving and transmitting secure electronic health information. When ELR health data has been verified for completeness, it enhances the ability to monitor HIV diagnosed patients for virologic failure that in some cases is associated with ADR. In recent years the transmission of HIV drug-resistant strains among persons with HIV has been an on-going concern. When drug-resistant HIV becomes resistance to more than one drug class, the control of viral replication becomes more difficult. Consequently, measuring the burden of antiretroviral resistance has risen in importance, ranking alongside other major public health concerns when planning HIV prevention campaigns. The analytical method illustrated here aims to improve monitoring of patients with increased viral replication that may lead to poor clinical outcomes and resistance to antiretroviral medications, leading to significant increases in monetary costs when prescriptions for secondline drug regiments are required.

Objective

The aim of this presentation is to illustrate a public health surveillance method for monitoring antiretroviral drug resistance (ADR) in persons diagnosed with human immunodeficiency virus infection (HIV). We developed procedures for examining HIV related electronic laboratory reports (ELR) transmitted to our health department surveillance system that link to corresponding clinical and demographic data for patients with varying degrees of antiretroviral drug resistance.

The Environmental Public Health Tracking Network (Tracking Network) is a national surveillance system that integrates environmental hazard, exposure, and health outcome data into one system. The Tracking Network launched in July 2009, and has since been receiving data from 23 funded state and local health departments, and several national partners, e.g., Environmental Protection Agency. Despite this success, some challenges exist in obtaining more timely and complete data to link risk factors, and assign exposure for health outcomes with long latency periods before their detection.

The Health Information Technology for Economic and Clinical Health (HITECH) Act (2009) facilitates the adoption of electronic health records (EHR) through incentivizing the meaningful use of certified EHR Technology. Meaningful use is a set of specific objectives and data exchange standards that eligible healthcare professionals and hospitals must achieve to qualify for the Centers for Medicare and Medicaid Services (CMS) Electronic Health Records Incentive Programs. Public health agencies in turn need to have the capacity to accept these data in the mandated standard and determine the potential and use of this increased data.

This presentation will discuss how the Tracking Network is exploring the use of EHR to meet Tracking Network surveillance challenges and provide other opportunities to enhance environmental public health surveillance. We will also present some results of these efforts.

Objective

This presentation will discuss how the Tracking Network is exploring the use of EHR to meet Tracking Network surveillance challenges and provide other opportunities to enhance environmental public health surveillance

Effective real-time surveillance of infectious diseases must strike a balance between reliability and timeliness for early detection. Traditional syndromic surveillance utilizes limited sections of the EMR, such as chief complaints and/or diagnosis. However, other sections of the EMR may contain more pertinent information than what is captured in a brief chief complaint. These other EMR sections may provide relevant information earlier in the patient encounter than at the diagnosis or disposition stage, which can appear in the EMR up to 24 hours after the patient’s discharge. Comprehensive analysis may identify the most relevant section of EMRs for surveillance of all major infectious diseases, including ILI.

Objective

To investigate which section(s) of a patient’s electronic medical record (EMR) contains the most relevant information for timely detection of influenza-like illness (ILI) in the emergency department (ED).

Since the largest epidemic of Zaire ebolavirus (EBOV) in recorded history began in Guinea in December 2013, the epidemic has spread to neighboring countries of Liberia and Sierra Leone resulting in an estimation of over 27,000 total cases and over 11,000 deaths to date. In response to the widespread social disruption caused by this epidemic in West Africa, President Obama committed approximately 2,000 US service members to deploy to the region and provide humanitarian aid. US military physicians were called upon to evaluate service members returning from West Africa (WA) to rule out EVD. The US military also has a considerable number of beneficiaries who travel to WA to visit friends and relatives placing them at risk for exposure to EBOV and the development of illness upon returning to the US.

We are conducting an expanded surveillance program that employs a standard questionnaire that all providers can use when evaluating a patient at-risk for EVD that will also capture information from historical encounters. The data collected from the questionnaire will be used to assess the frequency with which clinicians are called to evaluate patients for EVD and the resources required. However, we realize that many encounters may not be captured with this method, especially those that are not high enough risk to require consultation with infectious disease (ID) specialists, and are developing ways to screen the Electronic Health Record (EHR) to find additional patients.

Objective

To present methods of screening chief complaints and laboratory orders to find patients who presented for Ebola Virus Disease (EVD) screening, in order to determine the impact Ebola concern had on the Military Health System (MHS).

Health care reform and the use of electronic health record systems is dramatically changing the health care landscape creating both challenges and opportunities for public health. High adoption of health information technology among Minnesota’s health care providers has created an opportunity to advance e-health by collecting and using these data to improve population health. It has been demonstrated that interoperable clinical data repositories can serve surveillance needs to support both public health and clinical care. Additionally, health reform is fostering the need for the collection of data to manage population health, compare and share data locally and across states for care coordination, and monitor cohorts and attributed populations. This project will provide a critical understanding of the status, challenges, and opportunities for leveraging the substantial investment in health care data systems to better support public health prevention programs, epidemiology, and surveillance to improve population health, address health disparities, and advance health equity.

Objective

This project describes the informatics characteristics of clinical data repositories among Minnesota health systems and their opportunities and readiness to support public health practice. The focus of the study is the use of these data for public health prevention programs and surveillance, including the opportunities to address health disparities. We examine technical, organization, and process readiness of repositories in support of epidemiology and other key public health programs, and how these data can be used as a statewide public health resource. 

Traditional surveillance methods, such as registries that require manual validation of every diabetes case or questionnaires, are resource intensive and associated with considerable delay in reporting results. An EHR-based surveillance system may be more efficient for sustained monitoring of the incidence and prevalence of childhood diabetes, so as to inform health care needs for this growing population.

Objective

The study goal was to develop an efficient surveillance approach for childhood diabetes across two large Southeastern US public academic health care systems, using electronic health record (EHR) data.

It is estimated that in the United States (US), unintentional non-fire related CO poisoning causes an average of 439 deaths annually, and in 2007 confirmed CO poisoning cases resulted in 21,304 ED visits and 2,302 hospitalizations (71 per million and 8 per million population, respectively)1 . Despite the significant risk of morbidity and mortality associated with CO poisoning, existing surveillance systems in the United States are limited. This study is the first to focus specifically on CO poisoning trends within the VHA population.

Objective

To describe characteristics of Veterans Health Administration (VHA) patients with ICD 9/10 CM inpatient discharge and/or emergency department (ED)/urgent care outpatient encounter codes for carbon monoxide (CO) poisoning.

Electronic case reporting (eCR) is defined as the fully or semiautomated generation and electronic transmission of reportable disease case reports from an electronic health record (EHR) system to public health authorities, replacing the historically paper-based process. ECR has been reported to increase the number, accuracy, completeness and timeliness of surveillance case reports. Chicago Department of Public Health (CDPH) collaborated with Alliance of Chicago (AOC) to develop an application to generate electronic provider reports (ePR) for chlamydia (CT) and gonorrhea (GC) cases from the EHR system managed by AOC and send ePR records to the Illinois National Electronic Disease Surveillance System (I-NEDSS). This application was tested in the EHR database of Health Center A in AOC’s network. It is essential to ensure ePR data are accurate, so that public health receives correct information to take actions if needed. Therefore, evaluation is needed to assess ePR records data quality.

Objective

To describe the evaluation process to assess data quality during development of an electronic case report application, and to describe the evaluation results