CDC Sees EHRs As Public Health 'Game Changer'

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Sometimes forgotten in the rush to install electronic health records (EHRs) is that improving population and public health is a major goal of the federal meaningful use EHR incentive program. But many in the public health community are counting on greater EHR adoption and interoperability among physicians and hospitals to help identify and respond to future disease outbreaks, according to a top government health IT official.

"Public health agencies, from local to state to federal, have been building information technology for years, but because we don't have a lot of connections to y'all, we don't have a lot of information to share," Dr. Seth Foldy, director of the public health informatics and technology program office at the Centers for Disease Control and Prevention (CDC), said Tuesday. "In the future, we assume that most of our public health allies will be perched in front of their EHRs."

Speaking at the New York-based Institute for Health Technology Transformation's health IT summit in Atlanta, Foldy highlighted some of the successes that public health has had with health information exchange (HIE). According to Foldy -- a family physician, former head of public health agencies for the city of Milwaukee and the state of Wisconsin, and co-founder of the Wisconsin Health Information Exchange -- immunization registries represent "the original HIE."

Foldy said that the response to the 2009 pandemic outbreak of the H1N1 virus led to the largest mass vaccination effort in U.S. history. Thanks to online immunization registries, public health agencies were able to track administration of the vaccine and collaborate with insurance companies to identify high-risk enrollees who hadn't yet received the shot.

In 2003, while commissioner of the City of Milwaukee health department, Foldy helped conceive and quickly deploy a four-state network for detecting potential severe acute respiratory syndrome (SARS) cases based on symptoms reported from hospital emergency departments. That episode demonstrated to Foldy the "transformative" power of electronic reporting of laboratory data.

"We know that this is a game changer in terms of electronic reports about communicable disease," Foldy said Tuesday. And because manual reporting is a slow, labor-intensive process, electronic transmission of test results greatly accelerates the ability of public health officials to identify epidemics and pandemics. It also unlocks data that hospitals didn't even know was reportable, according to Foldy.

Foldy also spoke of an outbreak of cryptosporidium in Milwaukee's water supply in 1993 -- about three years before he took over the health department -- that caused nearly a quarter of the area's population to exhibit symptoms such as diarrhea, dehydration, and fever.

After officials identified the water-borne illness outbreak rather late in the epidemiological cycle, the city built an electronic "diarrhea meter" to track reported cases.

With the H1N1 outbreak in the Spring of 2009, "our entire school system was inundated with this virus," Foldy said. The CDC recommended considering closing school systems where more than one school was affected by H1N1, but that would involve shutting down 10% of public health capacity, since school nurses and other health workers saw so many children. The city's database helped make the case for keeping the schools open.

"The whole point of informatics is to add value," Foldy said. "Public health has one of the best use cases in the world for sharing health information."

When there's a change in healthcare policy, such as when research showed aspirin was an inexpensive yet effective way to prevent and treat heart attacks, doctors typically hand out leaflets to patients if they happen to remember to do so. "That's not the most efficient use of informatics," Foldy says.

Physicians don't have time to read faxed alerts until many cases have been identified, Foldy noted, so why shouldn't public health agencies send alerts electronically right into EHRs as soon as there's an identified outbreak?

"There's a big business case around all of us" in making sure electronic reporting succeeds in speeding up data exchange, Foldy said.