Integrating clinical practice and public health surveillance using electronic medical record systems

Abstract

Electronic medical record (EMR) systems have rich potential to improve integration between primary care and the public health system at the point of care. EMRs make it possible for clinicians to contribute timely, clinically detailed surveillance data to public health practitioners without changing their existing workflows or incurring extra work. New surveillance systems can extract raw data from providers' EMRs, analyze them for conditions of public health interest, and automatically communicate results to health departments. We describe a model EMR-based public health surveillance platform called Electronic Medical Record Support for Public Health (ESP). The ESP platform provides live, automated surveillance for notifiable diseases, influenza-like illness, and diabetes prevalence, care, and complications. Results are automatically transmitted to state health departments.

FIGURE 1—

Percentage of ambulatory patient visits fulfilling the Centers for Disease Control and Prevention syndromic surveillance definition for influenza-like illness: Atrius Health, October 2009–February 2012.

FIGURE 2—

RiskScape screenshot displaying the prevalence of type 2 diabetes by zip code among overweight and obese individuals with borderline or elevated blood pressure. Note. The RiskScape permits users to select surveillance outcomes, map results by zip code, stratify results by age, race/ethnicity, and sex, and compare disease prevalence by region.