Technology Using Electronic Health Records to Improve the
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1 Health Information Law and Technology Using Electronic Health Records to Improve the Public s Health David C Kaelber, MD, PhD, MPH, FAAP, FACP Internal Medicine and Pediatrics Physician Chief Medical Informatics Officer MetroHealth System Assistant Professor of Internal Medicine and Pediatrics Case Western Reserve University
2 Learning Objectives To demonstrate how electronic health record technology can transform the public s health. To identify some of the legal issues around using electronic health record technology for public health. Disclosures None (although tens of millions of dollars of None (although tens of millions of dollars of institutional funds are committed to Epic.)
3 Outline Background 2 Case Examples Discussion/Questions
4 Public Health and Clinical Medicine Traditionally public health professionals and clinical medicine professional worked in silos. Both are trying to improve the health of their constituents!
5 Public Health and Clinical Medicine As more clinical data resides in electronic health records the desire and need to leverage this resource for the public s health increase Utilizing i clinical i l medicine i data for public health purposes involves both technical and non-technical (mostly legal) issues!
6 Potential of EHR use for Public Health Epic Epic Epic Epic in OHIO MetroHealth Cleveland l Clinici Akron Children s Nationwide Children s Ohio State Children s of Dayton Cincinnati Children s Catholic Healthcare Partners The Christ Hospital TirHealth Kettering Health Network Premier Health Partners Upwards of 25% of the US population in Epic systems! Epic Epic Epic Epic Epic Epic Epic Epic OH has the most Epic installations in the US!
7 Outline Background 2 Case Examples Discussion/Questions
8 Case 1 Electronic Support for Public Health (ESP) Can we use informatics tools to improve infectious disease detection and reporting for the public s health? Yes!
9 Electronic Support for Public health (ESP) Software and architecture to extract, analyze, and transmit electronic health information from providers to public health. Surveys codified electronic health record data for patients with conditions of public health interest Generates and sends secure electronic reports to the state health department Designed to be compatible with any EHR system JAMIA 2009;16:18-24 MMWR 2008;57: Advances Disease Surveillance 2007;3:3
10 Public Health Reporting Old New Metrohealth Ohio Department of Health
11 ESP Case Reporting The MetroHealth System, January 2009-December 2009 Condition Total Cases False Positives Positive Predictive Value Chlamydia % Gonorrhea % Increased sensitivity, specificity, accuracy, completeness, and efficiency of data exchange!
12 Manual versus electronic reporting MetroHealth, January 2009 December 2009* Manual Reports ESP Change Chlamydia % Gonorrhea % Acute Hepatitis B % Acute Hepatitis C % *The Ohio Department of Health is ~6 months The Ohio Department of Health is 6 months behind entering Chlamydia and Gonorrhea data.
13 Time savings The MetroHealth System (MHS) Time per case MHS Record Positive Lab Information MHS Record Additional Patient Information MHS Push paper MHS Envelope/Postage 74 sec 87 sec 60 sec 30 sec ODH Data Re-Entry 420 sec TOTAL 671 sec (~11 min)
14 Annual cost savings The MetroHealth System Annual Savings* MetroHealth $4,698 Ohio Department of Health $8,316 Total for THIS ESP project $13,014 TOTAL for United States $7 million *Only accounts for costs associated with Chlamydia and Gonorrhea.
15 More Information about ESP ESP website: MMWR report on ESP: Article on identifying acute hepatitis B from EMR data using ESP: /journal.pone The MetroHealth System is the second site in the world to implement ESP ( GO LIVE 9/15/2010).
16 Case 2 Better Health Greater Cleveland Can we use informatics tools to report on and improve the health of a community to improve the public s health? YES!
17 Better Health Greater Cleveland l Collaboration committed to improving the health and the quality of care for Greater Cleveland's residents with common chronic medical conditions. Cleveland Clinic, MetroHealth, University Hospitals, VA, private practices, community healthcare centers. Focusing initially on community-wide diabetes care, and expended to high blood pressure and congestive heart failure..
18 Diabetes outcome and care process measures in 2007 and 2008 by insurance (top) and medical record source (bottom). Community Health Checkup (June 2009)
19 Better Care, Better Outcomes Are Your Patients Outcomes Improving? Diabetes Trends
20 Replicable Best Practices From Discovery through Re- Measurement Pneumococcal Vaccinations in Diabetes
21 Partner Practices: Is Your Practice on the Map?
22 Outline Background 2 Case Examples Discussion/Questions
23 Health Informatics is already beginning to transform public health and is blurring the traditional lines between public health and clinical care to improve the public s health. THE FUTURE IS NOW!
24 Questions? Comments?
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