Electronic Health Record (EHR)

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

Clinical data captured in electronic health records (EHR) for patient health care could be used for chronic disease surveillance, helping to inform and prioritize interventions at a state or community level. While there has been significant progress in the collection of clinical information such as immunizations for public health purposes, greater attention could be paid to the collection of data on chronic illness. Obesity is a chronic disease that affects over a third of the US adult population1 , making it an important public health concern. Both HL7 v.2.5.12 and Clinical Document Architecture (CDA) messages3 can be used to facilitate the collection of HW EHR data. These standards include anthropometric and demographic information along with the option to transmit behavioral, continuity of care, community resource identification and care plan information. We worked with vendors participating in the Integrating the Healthcare Enterprise initiative (IHE) in developing, testing and showcasing scenarios to facilitate system development, increase the visibility of HW standards and demonstrate potential usages of obesity-related information.

Objective

To demonstrate the feasibility of using healthy weight (HW) IT standards in public health surveillance through the collection and visualization of patient height, weight and behavioral data.