Public Health Surveillance Using Electronic Health Records

Abstract

Background: Public health surveillance has traditionally relied on manual processes including paper-based reporting by clinicians. The introduction of electronic laboratory reporting increased the efficiency and completeness of infectious disease surveillance but clinical and risk factor data are often still collected manually. The use of electronic health records (EHR) has significant promise to enrich surveillance by collecting these data automatically and by expanding surveillance to chronic diseases (e.g., diabetes, hypertension, obesity). However, the extent of the use of EHRs for public surveillance is not well studied. Evidence Acquisition: The peer-reviewed medical literature was searched for descriptions of the use of EHRs for public health surveillance. Evidence Synthesis: This literature is very limited. The largest body of work describes the experience of the Electronic Medical Record Support for Public Health system (ESPnet) currently being used in Massachusetts, Ohio, and Texas. It shows both the potential and challenges of using EHRs for surveillance. Discussion: Routine incorporation of EHR data into surveillance provides a unique opportunity to expand the breadth, quality, and efficiency of surveillance efforts. However, more research is needed to document the potential benefits and limitations of EHRs. Implications: Surveillance practitioners should work with health systems and EHR vendors to explore the use of EHRs. Policymakers should increase financial support for EHR-based surveillance by building requirements into Meaningful Use and other initiatives. In addition, clinical medicine and public health should work together to develop meaningful surveillance measures that can simultaneously improve the care of individuals and populations.