Electronic medical records could enable faster, more accurate and more comprehensive reporting of diseases than traditional physician-initiated or even automated laboratory-based reporting systems, according to the results of a recent pilot project led by researchers from Harvard Medical School and the Massachusetts Department of Public Health (DPH).
Those findings — based on a yearlong study of EMRs and conventional reporting efforts at Atrius Health, a multispecialty practice that serves approximately 600,000 patients in eastern Massachusetts — were published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR).
Researchers noted that many EMRs contain key data points for public health, including patient symptoms. EMRs also integrate multiple laboratory tests and store the data "in a form that is amenable to electronic analysis and reporting,” according to the report.
The pilot project tested an automated system called Electronic Support for Public Health (ESP), which analyzes EMR data for notifiable diseases and reports such cases to public health authorities.
ESP was created by the Massachusetts DPH, Harvard Pilgrim Health Care, the Department of Ambulatory Care and Prevention at Harvard Medical School, Atrius Health and the Channing Laboratory of Brigham and Women’s Hospital with funding from the CDC Center for Public Health Informatics.
During the study, Atrius’ EMR system transferred various data on patient visits — including patient demographics, vital signs, test results, prescriptions and diagnostic codes — to the ESP server every 24 hours. ESP then analyzed the data for evidence of four diseases: chlamydia, gonorrhea, pelvic inflammatory disease and acute hepatitis A. Conventional reporting continued as usual, and Atrius personnel were unaware of cases identified through ESP, the study said.
From June 2006 through July 2007, ESP reported 75 percent more cases of acute hepatitis A, 53 percent more cases of gonorrhea and 39 percent more cases of chlamydia than passive surveillance methods. In addition, ESP caught 20 cases of pelvic inflammatory disease, compared with none identified by passive surveillance. It also identified 81 pregnancies in women with chlamydia or gonorrhea that were not included in passive surveillance reports.
Overall, researchers wrote in the MMWR, the findings illustrate “that automated, active surveillance using EMR data has the potential to improve public health monitoring by ensuring that cases are reported and by enhancing the timeliness, accuracy and clinical detail of reports.”
The researchers added that a number of challenges exist to wider use of EMR-based surveillance and reporting of diseases, including limited adoption of EMR technology by small clinics and physician practices, differences in coding practices in proprietary EMR systems, and differences in the types of patient data collected by EMR systems.
However, based on their findings, researchers said that EMR-based reporting can help public health departments better spend limited dollars on the most critical needs. EMRs also more reliably identify high-priority cases for intervention and provide support for other public health practices, “such as populating immunization information systems or enabling statistical analyses for outbreak detection and investigation.”
Government Health IT presents Rick Friedman, director of the division of state systems for the Center for Medicaid and State Operations with the U.S. Department of Health and Human Services, in this recent eSeminar regarding how the federal Centers of Medicare and Medicaid Services is partnering with state Medicaid and health and human services officials to bring Medicaid into the digital age. Paul McCloskey, Government Health IT editor, moderates.
