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
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
Outline
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Overview of the Tracking Network and data
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Objectives of EHRs activities and projects
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Overview of results
Environmental Public Health
Tracking Network
...a system of integrated
health, exposure, and
hazard information and
data from a variety of
national, state, and city
Current Content and Data
Environment Data
•
Climate Change
•
Community Design
•
Homes
•
Outdoor Air
•
Water
•
Pesticides
Population Health
•
Biomonitoring
•
Children’s Environmental
Health
Health Effects Data
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Asthma
•
Birth Defects
•
Cancer
•
Carbon Monoxide Poisoning
•
Childhood Lead Poisoning
•
Developmental Disabilities
•
Heart Attacks
•
Reproductive and Birth
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?
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
Benefits to Public Health
Enhance public
health
surveillance
Improve public
health outcomes
Why Now?
HITECH 2009 incentivizes adoption of
meaningful use of EHRs technology
Meaningful Use
•
Using certified EHR technology in a meaningful
way
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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
Tracking EHR Activities
•
EHR and Tracking Project
•
Vendor demo
•
CDC EHR initiatives
–
Public Health Tiger Team
•
Office of the National Coordinator (ONC)/CDC
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Structured data capture
•
Data access framework
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MU public health and vendor calls
•
ACA, EHR and community health needs
assessments workgroup
What data can Tracking use
from an EHR?
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
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
Several potential data partners for a pilot project
•
Masachussetts Department of Public Health Network
(MDPHnet)
–
influenza-like illness and diabetes
•
New York City Macroscope
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BMI, hypertension, diabetes, tobacco use and flu vaccine uptake
•
BioSense
EHR & Tracking Project:
Key Findings (cont.)
EHR and Tracking Project:
Final Report
•
Potential priority health
data from EHRs
•
Use-cases
Prioritizing Tracking Data
Factors we can consider
–
No population-based registries
–
Environmental health (EH) risk factors not well
known
–
No national prevention strategies
Prioritizing Tracking Data
Health Outcome Data
•
Birth defects
–
Not all states have population-based birth defects registries
–
Only 14 Tracking states report
•
Developmental disabilities
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Autism data from 14 sites
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Risk factors not well understood
•
Hospitalization and Emergency department
–
Opportunity to get more of these data
•
Current: AMI, Asthma, Heat stress, CO poisoning
Prioritizing Tracking Data
Other Data
•
Other data to consider
–
Flu-like illness
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Allergies and allergy testing
Prioritizing Tracking Data
Exposure Data
•
Blood lead poisoning
–
Timely, cost-effective
•
Other exposure data?
–
Heavy metals, pesticides
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Markers of inflammation, carboxyhemoglobin,
cotinine
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EHR data may not be representative
What data can be included
in EHRs?
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
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adding structured historic residence data to EHRs
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Pilots on-going
EHR Vendor Demo
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MU stage 2 certified
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Direct reporting of data from EHRs to
Cancer Registries
Other Data To Consider
Home
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Type of housing
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Chemical products used
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Appliances used
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Number of smokers in
homes
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Location
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Private well water
Occupational
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Type of work
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Exposure periods
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Products used at
How can Tracking data
be used in EHRs?
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
On-going
•
Pilot projects with Tracking grantees
•
Objective:
feasibility of integrating EHR into the
state/local networks and the National Tracking
Network
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NYC: validity of EHRs data for population health
indicators
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MA: validity of EHRs data for population health
indicators
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MO: Develop core data elements from EHRs for
environmental public health tracking
Next steps
•
White paper
Visit the Tracking Network today!
www.cdc.gov/ephtracking
Info about the Tracking Program
www.cdc.gov/
nceh/tracking
Contact Us
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
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
