Abstract
BackgroundDeveloping a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way.MethodIn this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor.ResultsFrom our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it.ConclusionsDespite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health.
Highlights
Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult
Structured data is the crux of public health functionality because it enables: quality measures to assess ambulatory care quality, clinical decision support systems (CDSS) to communicate best clinical practices to providers, and public health interfaces to link with existing Department of Health and Mental Hygiene (DOHMH) systems
Before implementing EHR systems in the community, the DOHMH tried to take advantage of existing technological innovations to improve the disparity of health care through the distribution of personal digital assistants (PDA) to physicians working in federally-funded community health centers [5]
Summary
Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. The goal of TCNY is to improve population health by helping New Yorkers take discrete and identifiable steps to improve their health through focusing on ten items ranging from prevention to health screening and chronic disease management. After identifying these ten areas (see Table 1), the DOHMH, guided Commissioner Thomas Frieden, tracked these TCNY measures to monitor the city’s progress [1]. Recognizing the opportunity to improve care and collect data on the TCNY defined clinical areas, PCIP, in collaboration with our selected EHR vendor, developed the corresponding TCNY quality measures for use at the point of care. Within the EHR, these CDSS alerts inform the provider by a series of prompts on their computer screen that the patient they are currently seeing in their office is due for specific health maintenance screenings or chronic disease management based on the patient’s age, gender, and comorbidities
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