When someone says the word “EHR,” what do you think of? For some providers, the word could trigger an instant headache as they mull over how time-consuming EHRs can be to use. But new research shows EHRs can be of particular use in population health surveillance.
This finding begins with the NYC Macroscope, an EHR surveillance system created by a group of health IT experts, clinicians and epidemiologists. By aggregating information from EHRs throughout New York City, NYC Macroscope is able to gather data on numerous chronic conditions.
In 2013, the group compared the NYC Macroscope data to information from the NYC Health and Nutrition Examination Survey, or NYC HANES, and the NYC Community Health Survey, which are in-person and telephone surveys the city uses to gather health information on New Yorkers.
As it turns out, the data from the NYC Macroscope was fairly comparable to data from the surveys — at least in some regards. The data sets had similar results for conditions like diabetes, hypertension, obesity prevalence and smoking. But NYC Macroscope fell short in measuring high cholesterol, influenza vaccination and depression.
These findings were recently published in a commentary piece in the American Journal of Public Health. Authors include individuals from the New York City Department of Health and Mental Hygiene, as well as Lorna Thorpe, PhD, professor and director of the division of epidemiology at the NYU School of Medicine’s Department of Population Health.
Thorpe discussed the research in a phone interview with MedCity. “What we learned is generally if it’s documented well in the EHR, we can take a large sample of EHRs from primary care practices and generate good estimates,” she said. “But if it’s not measurable in the EHR, then it doesn’t do a good job.”
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
And conditions like high cholesterol, influenza vaccination and depression are more challenging to document and measure in the EHR. The screening periods for high cholesterol are fairly irregular. “It’s not captured as accurately in the EHRs,” Thorpe said. Because individuals aren’t always getting their flu vaccination from their primary care provider, the EHR data on it isn’t accurate. And with depression, many primary care providers either don’t screen for it or don’t document it well in the EHR.
Thorpe believes this methodology could be of use outside New York City. For example, it presents an ideal opportunity in rural settings where there are typically only one or two major healthcare providers. “In the presence of a network that captures much of the community, this is a potential source of health information,” Thorpe said.
But let’s not forget about those pesky EHRs. Do the benefits shown in this research outweigh the challenges EHR users face every day? While the findings don’t solve EHR users’ problems, the data aggregated via EHRs can prove extremely advantageous. “I do think this is an increasingly important source of information that can help us improve population health and understand population health better over time,” Thorpe said.
Photo: FotografiaBasica, Getty Images
