Electronic Health Records: Key to Tracking Epidemics

It’s the stuff nightmares (or at least Hollywood blockbusters) are made of: Patient 0 eats a bad piece of meat and contracts a particular virus strain. She sneezes in the vicinity of Patient 1 and he contracts the virus as well. He spreads it to his family, including his school-aged son (Patient 2) who unwittingly goes to school that next day and spreads it to all students in his third-grade class. In a matter of days, the entire city is infected. 

While that scenario is certainly heightened, a recent New York Times article detailed the very real importance of electronic health records (EHRs) for public health officials who study data to determine whether diseases like the flu may be on the rise, and to monitor the effects of heat waves, food-borne illnesses, etc. 

While Care360 is proud of the many benefits its EHR affords, including time efficiencies and streamlining processes, we are excited to share this article with our customers as it demonstrates how EHRs can also inspire real societal change and improve overall public health. 

More and more doctor’s offices are able to submit electronic data to public health agencies as the use of EHRs increases due to the Centers for Medicare and Medicaid (CMS) EHR Incentive program. The requirements to collect the incentives include public health objectives that directly support these initiatives. Specifically, the provider’s EHR must have the capability to provide electronic syndromic surveillance data to public health agencies.   

The Value of EHRs

The key conclusion from the article indicates the immense value of EHRs: “By combing through the data now received almost continuously from hospitals and other medical facilities, some health departments are spotting and combating outbreaks with unprecedented speed,” wrote Milt Freudenheim of the New York Times

Dr. Seth Foldy, a senior adviser to the Centers for Disease Control and Prevention, put it even more succinctly: “Technology is helping officials faced with events of public health significance to know sooner, act faster and manage better.” 

The article also offers some examples of the powerful role EHRs played in identifying and rectifying health situations of significance. In February 2012, Michigan officials noted an increase in the number of patients who had E. coli, including six who were hospitalized, because of information gleaned in EHRs. In less than a week, health officials were able to identify the source of the outbreak: clover sprouts from a Jimmy John’s sandwich chain, and warn the public against ordering sprouts until the contamination had been resolved. 

David A. Ross, director of the Public Health Informatics Institute, a nonprofit organization that helps write digital standards, was quoted as saying that EHRs enable officials to “…see it in real time and zero in on the cause faster. That can save both lives and money.” 

Example of Data Use in Massachusetts

The Times article says that electronic records are being used in Massachusetts to quickly identify and locate babies at risk for hepatitis B infection. The state health department’s software sifts through the more than 100,000 electronic reports transmitted annually and each year, identifies more than 1,500 cases of hepatitis B for follow-up. Health officials alert the medical providers of infected women ages 14-44, and the providers in turn identify individuals in that group who are pregnant or recently gave birth. The newborns are vaccinated and then monitored. 

Using paper records, according to the Times, means that locating those vulnerable babies could take weeks or months. “That would be too late to be of benefit to the newborn,” said Kevin Cranston, director of the infectious disease bureau at the Massachusetts Department of Public Health. Without early protection, these babies face lifelong infection with hepatitis B and possibly liver disease, cirrhosis and cancer. The article noted that while the Centers for Disease Control and Prevention recommends prompt hepatitis B vaccination for all newborns, four in 10 did not get that protection according to a 2011 report from the agency. 

So when you choose to adopt an EHR, your choice not only impacts your practice and patients, but could also have a positive impact on the health of the entire population.  

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Comments

Electronic Health Records: Key to Tracking Epidemics — 1 Comment

  1. The healthcare idnsutry has deployed a variety of technological solutions in an effort to bring about cost-effective clinical documentation. I think it’s fair to say that none have worked. Point-and-click approaches detract from the patient-physician interaction if done during the encounter. They take considerable time if performed after the encounter. Front-end speech recognition consumes valuable physician time, both dictating and correcting. Back-end speech recognition just takes the physician’s time to dictate, but it adds delay and expense for a medical editor to correct the draft text. It’s only a marginal improvement over conventional dictation and transcription. Plus, the free-text speech applications will require natural language processing to extract the clinical facts and convert them to codes, in order to qualify for future stages of meaningful use. And a code editor will be needed to correct the engine’s errors. Then the codes will have to be mapped to the EHR’s data fields, and that’s a messy process.Surprisingly, if not shockingly, the ultimate answer seems to lie not in technology…but in people. The new profession of Medical Coordinators (MCs) has proven to be a powerful solution to the conundrum of clinical documentation, while providing other valuable benefits as well. Early adopters are seeing dramatic productivity increases, with the ability to see one additional patient per hour. This pays for the MC while adding six figures to the physician’s income. Equally important is that the physicians are now enjoying the practice of medicine again, exercising their minds more than their fingers. And their patients love the way they listen and analyze, with eye contact, rather than worrying about entering data into the computer.The MCs are not in the exam room. They can be in another office of the building or in their home. They listen to the patient and physician via a secure, two-way microphone/audio connection. Having been trained to be expert in the EHR and in performing the documentation from listening to the audio, which is a formidable challenge, they enter the appropriate codified data and narrative text into the EHR. The information appears (almost magically) on a monitor in the exam room. Or the physician can utilize an iPad.When the encounter is over, the documentation is finished. The MCs also handle the encounter-related workflow. They can get the nurse to the exam room when indicated, do the e-prescribing, assure all the necessary clinical reports are available, remind the physician about something the patient wanted, etc. When encounter is over everything is done. The MC can even do the coding.

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