Jun 22, 2010 (CIDRAP News) – An informatics expert from the US Centers for Disease Control and Prevention (CDC) today spoke with clinicians about possible public health connections to electronic medical records, which she said could have been useful during the H1N1 pandemic and might ease information flow during future public health events.
The discussion follows recent federal investments to promote greater use of health information technology.
In March, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the award of $162 million in economic stimulus funding designed to ease health information exchange and further health information technology (IT). The funding is part of a wider $2 billion effort to encourage more meaningful use of health IT and an electronic health record (EHR) for every citizen by the year 2014, according to a Mar 15 HHS press release.
In a clinicians conference call, Nedra Garrett, acting director of the CDC's division of informatics practice, policy, and coordination, said recent health IT and EHR incentives present tremendous opportunities for public health. She said challenges are to connect public health alerts and guidance to relevant patient data in the EHR and to make sure systems have a meaningful impact on point-of-care practices, such as ordering lab tests and distributing educational information to patients.
She said the CDC envisions working with other government agencies to employ other public health EHR-based IT applications such as food recalls and vaccine adverse event reporting.
As an example of how the system would work, a patient presenting to a doctor's office with flu symptoms such as cough, chills, and fever would generate an anonymous electronic patient profile containing the symptoms and the provider and patient's zip code that transmit to a central alert repository, which would send the physician diagnosis, treatment, and prevention resources targeted to the patient.
Garrett added that the anonymous patient profile could also include useful public health data such as the patient's occupation or recent travel history.
Having public health systems interface with EHR might be able to prevent clinicians from being bombarded during health emergencies, as they were during the H1N1 pandemic with multiple sources, some of which provided contradictory information.
Garrett said clinicians will be most likely to find EHR-based public health alerts useful if they strike a balance of providing the most relevant information at the right time. She said an alert system would also likely include a severity scale to help clinicians gauge the urgency of the notices.
Though the concept is still in its infancy, Garrett said the CDC has launched a small pilot program in an ambulatory setting. The CDC is collaborating with 10 providers of a GE Healthcare customer site in Chicago. The project is focusing on foodborne disease alerts, and Garrett said the CDC hopes to have preliminary findings by the end of the year.
"Researchers can evaluate how often we need to trigger the alerts and how specific the information needs to be," she said.
During the question-and-answer part of the conference call, clinicians seemed eager to broaden the public health applications for EHR beyond just public health alerts to include functions such as surveillance and disease reporting. However, they also had concerns about local health and emergency medical service officials being included in the system, the scope of the information that the public health system might pull from medical records, and the interoperability between different EHR systems.
Garrett said there are several complicated issues to sort out, such as making sure rules and governance issues are addressed. "We have more questions than answers, but we are moving in the right direction," she said.
Mar 15 HHS press release
CDC Clinicians Outreach and Communication Activity (COCA) conference PowerPoint slides