1 Electronic Health Records and Environmental Public Health Tracking Gonza Namulanda, DrPH, MS, Health Scientist Environmental Health Tracking Branch Presented at the International Society for Disease Surveillance December 11 th, 2014, Philadelphia
2 Disclaimer q The findings and conclusions in this presentation are those of the presenter(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
3 Outline q Overview of the Tracking Network and data q Objectives of EHRs activities and projects q Overview of results q On-going projects and Next steps
4 Environmental Public Health Tracking Network...a system of integrated health, exposure, and hazard information and data from a variety of national, state, and city sources. 4
5 Tracking Network Grantees 25 States and 1 City 5
6 Current Content and Data Health Effects Data Asthma Birth Defects Cancer Carbon Monoxide Poisoning Childhood Lead Poisoning Developmental Disabilities Heart Attacks Reproductive and Birth Outcomes Environment Data Climate Change Community Design Homes Outdoor Air Water Pesticides Population Health Biomonitoring Children s Environmental Health Health Behaviors Population Characteristics 6
7 7 Objectives Explore: 1. What data can Tracking use from electronic health records (EHR)? 2. What other information can be included in EHR to improve environmental public health surveillance? 3. How can Tracking data be used in an EHR?
8 8 Electronic Health Records Electronic Health Record (EHR) a longitudinal electronic record of patient health info generated by one or more encounters in any care delivery setting Uses automate provider s workflow assist providers in making patient care decisions Access data from other systems: pharmacy & lab
9 9 Benefits to Public Health Enhance public health surveillance Improve public health outcomes
10 10 Why Now? HITECH 2009 incentivizes adoption of meaningful use of EHRs technology
11 Meaningful Use Using certified EHR technology in a meaningful way Ensuring that this technology can electronically exchange health info to improve quality of care Ensuring that the providers of this technology submit information on quality of care and other selected measures to Secretary of HHS 11
12 What have we done so far? 12
13 Tracking EHR Activities EHR and Tracking Project Vendor demo CDC EHR initiatives Public Health Tiger Team Office of the National Coordinator (ONC)/CDC Structured data capture Data access framework MU public health and vendor calls ACA, EHR and community health needs assessments workgroup National Center for Environmental Health, CDC 13
14 What data can Tracking use from an EHR? 14
15 EHR & Tracking Project Focus Opportunities, challenges, and uses of EHR data Data from EHR that tracking can use Other info that needs to be included in EHRs for environmental public health surveillance Interviews with 8 experts Federal, state & other public health agencies Research on existing EHR data 15
16 EHR & Tracking Project: Key Findings Many challenges to using EHR data Policy and patient privacy issues Differing data reporting structures and EHR software platforms EHR Customization Lack of common data elements and reporting practices Several different EHR data sources exist Commercial data sources (e.g., Community Care Network, VA) State Health Information Exchanges Distributed databases (e.g., Food & Drug Administration mini- Sentinel) 16
17 17 Several potential data partners for a pilot project Masachussetts Department of Public Health Network (MDPHnet) influenza-like illness and diabetes New York City Macroscope BMI, hypertension, diabetes, tobacco use and flu vaccine uptake BioSense EHR & Tracking Project: Key Findings (cont.)
18 18 EHR and Tracking Project: Final Report Potential priority health data from EHRs Use-cases Pilot project collaborators
19 19 Prioritizing Tracking Data Factors we can consider No population-based registries Environmental health (EH) risk factors not well known No national prevention strategies High priority health outcomes for EH
20 Prioritizing Tracking Data Health Outcome Data Birth defects Not all states have population-based birth defects registries Only 14 Tracking states report Developmental disabilities Autism data from 14 sites Risk factors not well understood Hospitalization and Emergency department Opportunity to get more of these data Current: AMI, Asthma, Heat stress, CO poisoning Other data: Ischemic heart disease, COPD More timely 20
21 21 Prioritizing Tracking Data Other Data Other data to consider Flu-like illness Allergies and allergy testing Risk factors
22 22 Prioritizing Tracking Data Exposure Data Blood lead poisoning Timely, cost-effective Other exposure data? Heavy metals, pesticides Markers of inflammation, carboxyhemoglobin, cotinine EHR data may not be representative Historic residence information
23 23 What data can be included in EHRs?
24 24 Structured Data Capture Initiative ONC initiative collaboration with CDC Purpose: To define requirements (including metadata) that will drive the identification and harmonization of standards to facilitate the collection of supplemental EHR-derived data Environmental health use-case adding structured historic residence data to EHRs Pilots on-going Future collaborations
25 25 EHR Vendor Demo MU stage 2 certified Direct reporting of data from EHRs to Cancer Registries Customizable forms
26 Other Data To Consider Home Type of housing Chemical products used Appliances used Number of smokers in homes Location Private well water Occupational Type of work Exposure periods Products used at work
27 How can Tracking data be used in EHRs? 27
28 28 Community Health Assessments EHRs, Affordable Care Act, and Community Needs Assessment Workgroup NCEH/ ATSDR How environmental health data can be used for community health needs assessments Can this be part of a clinical decision support?
29 29 On-going Pilot projects with Tracking grantees Objective: feasibility of integrating EHR into the state/local networks and the National Tracking Network NYC: validity of EHRs data for population health indicators MA: validity of EHRs data for population health indicators MO: Develop core data elements from EHRs for environmental public health tracking CA: Predictive power of EHRs real-time data
30 Next steps White paper Findings from pilot projects 30
31 Thank you!
32 Visit the Tracking Network today! Info about the Tracking Program nceh/tracking Contact Us
33 Data Access Framework Use Cases Scenario Scenario Descrip-on Exis-ng Standards Implementa-on Profiles Environmental Health 1. Asthma Asthma exacerba6ons are triggered by many factors including allergic and irritant triggers, changes in medica6on adherence, stress and emo6ons, as well as inherent fluctua6ons in the disease itself. Although worsening of outdoor air quality appears to be associated with an increase in asthma exacerba6ons, other factors contribu6ng to poor asthma control should be controlled for when analyzing this associa6on. The use of electronic health records facilitates linking these other causal factors as well as air quality measures, with the frequency of exacerba6ons on a popula6on level. Types of data that could be in EHRs: a. Informa6on that would indicate an allergic cause of an asthma exacerba6on: e.g., allergy tes6ng, and non- asthma diagnoses such as rhini6s and allergic conjunc6vi6s b. Indica6on of the severity and level of control of the disease: e.g., ED visit or hospitaliza6on for asthma, level of asthma control, and medica6ons Informa9on needs: query across primary care and relevant specialists (allergists and pulmonologists). Also, from the lab or pharmacy systems ICD 9/10
34 Data Access Framework Use Cases cont. Scenario Scenario Descrip-on Exis-ng Standards Implementa-on Profiles Environmental Health 2. Radia6on The most common source of man- made radia6on exposure is medical radia6on which includes exposure from CT scans, x- rays, and nuclear medicine. Children can be more vulnerable to radia6on injuries than adults, and therefore limi6ng the radia6on dose they receive is a public health concern. Limi6ng childhood radia6on exposure can reduce the risk of adverse health outcomes later in life e.g., cancer. Though it is difficult to measure the dose of radia6on received during a procedure, one way of es6ma6ng radia6on dose is through the number of medical radia6on procedures performed. Electronic health records can be an excellent source of informa6on on the number and types of medical radia6on procedures performed on children that can be aggregated for public health surveillance on radia6on exposures. Types of data that could be in EHRs: a. Types of medical radia6on procedures: e.g., CT scans, X- rays, nuclear medicine Informa9on needs: query across different pediatric hospital systems ICD 9/10