Can EHRs power up the fight against epidemics?
Government health IT leaders say electronic health record systems can expand information sharing and help public health responders fight the spread Ebola and future viruses.
While the United States avoided a public health crisis from the Ebola virus, the possibility of an epidemic at home got government health IT leaders thinking about how electronic health records might be used to expand information sharing and help public health responders fight the spread of Ebola and future viruses.
There are significant hurdles to clear before the EHRs used in clinical care will be able to really help state, local and federal health officials track and respond to fast-moving outbreaks in real time, according to those at recent Health IT Policy Committee meeting on the potential for using EHRs to fight epidemics.
The problem of interoperability and data transfer between EHR systems, medical laboratories and public health databases is one big issue. More broadly, there is a lack of what experts call "bidirectionality" between health records, preventing health officials – either for technical or privacy reasons – from accessing individual patient records.
For example, New York City is trying to get a handle on the spread of the chikungunya virus, a mosquito-borne disease that travelers from the Caribbean are increasingly bringing to the United States. Dr. Annie Fine, an epidemiologist with the New York City Department of Public Health, noted that patient addresses are often omitted from test results for the virus that are filed with the city.
That makes it harder for public health workers to follow up with infected individuals. Bringing disparate systems that were never designed to work together can be problematic, Fine said. "There are opportunities for failure and data problems at each integration point," she said.
Dr. John Loonsk, chief medical information officer at CGI Federal, echoed this point, noting that while physicians and labs are required to report to state and local officials on identified public health threats, sometimes key clinical information is omitted from lab reports.
However, in some cases existing EHRs can be modified to respond to particular ongoing health crises to support clinical care. In the Ebola reposnse, EHR vendor Cerner was able to insert clinical questions into its basic emergency room intake interface to get health workers to ask patients about travel to affected regions and relevant symptoms.
One big takeaway, said Brian Clark, Cerner's managing director for emergency solutions, is that the data on ongoing epidemics is from the Centers for Disease Control and other government agencies is scattered and hard to aggregate inside an EHR for use by clinicians.
Clark suggested use of a "standards-based surveillance app" that could operate on any certified EHR system to supply up-to-date government information and guidance on disease outbreaks.
Janet Hamilton, an epidemiologist with the Florida Department of Health, also noted that better electronic records exchange systems would minimize the time spent by doctors and health professionals reporting basic facts to officials and maximize the time they spend treating patients.
Ultimately, broader use of EHRs to detect and respond to epidemics will require changes in technology. The passive surveillance of patient EHRs using analytic tools could give greater velocity to detecting not just viral disease outbreaks, but environmental risks, contaminated food and medicine as well as other large-scale health problems that are clustered geographically or in certain demographic groups.
That’s not to say epidemiology is lacking in high-tech approaches. New York City, for example, was able to use cell phone location information and subway fare card data to conduct contact tracing on individuals that may have come into contact with the Ebola virus while traveling. However, aggregating that information, and making it available at scale through an EHR platform, appears to be a long way off.
This article originally appeared on FCW, a sister site to GCN.