EHR data could allow for dramatic improvements in addressing community health challenges, according to a recent report released by the de Beaumont Foundation and Johns Hopkins Bloomberg School of Public Health.
Researchers presented six use cases to illustrate how EHR data could help public health agencies make progress on childhood asthma – a common and preventable chronic illness.
“Asthma is a disease of individuals, many of whom require daily medication to prevent serious exacerbations,” wrote authors in the report. “At the same time, asthma is a disease of the community, with poor housing conditions and air pollution leading to significant clusters of illness.”
Utilizing EHR data can improve surveillance, geographic analysis, identification of high risk patients, clinician engagement, and evaluation of interventions for individuals with childhood asthma. Furthermore, researchers suggested these uses for EHR data could also be applied to other, more pressing public health challenges such as the opioid epidemic.
In addition to each use case, researchers also employed standard legal research methods and consulted secondary sources and practice materials to analyze how HIPAA recognizes the need for public health agencies to access protected health information (PHI).
“To do so responsibly and successfully under the law, public health agencies must be clear about their goals, specific in their requests, and take steps to assure the confidentiality of key data,” wrote researchers.
As part of the first use case, researchers demonstrate how EHR data can be used to determine whether rates of childhood asthma are rising or falling.
“Data reflecting time trends of asthma morbidity might allow the health department to strategically time the implementation of interventions to maximize impact,” suggested researchers. “Time series data pertaining to asthmatic episodes might also be used to inform health messages to the public about environmental conditions that are likely to trigger asthma attacks.”
The health department could request a weekly data file from each area hospital to obtain information about residents under the age of 21 that were diagnosed with asthma during an emergency department visit or hospital admission.
“The health department will combine and analyze the hospital data on a weekly basis for internal use,” wrote researchers. “These reports will inform program development and facilitate monitoring of the burden of disease.”
To determine the location of housing conditions that may trigger childhood asthma, researchers explained that public health officials could request a regular data file from area hospitals and identify specific geographic areas of the highest risk.
“Once identified, the health department will assess the external air quality in the vicinity and offer the services of environmental inspectors to assess home hazards to all in the area,” stated researchers.
The third example researchers illustrate to show the potential uses for EHR data involves identifying children with severe asthma that could benefit from evidence-based, at-home services. Again, the health department could request a regular data file from area hospitals at least weekly.
“The health department will combine these data to develop a registry of children admitted to the hospital for asthma,” researchers stated. “Those most frequently admitted will be contacted by the health department and offered home visits and care coordination.”
The fourth use case demonstrates how EHR data could be useful in allowing health departments to develop a tool to flag patients with severe asthma and alert clinicians about the existence of care plans.
“The health department is interested in alerting emergency departments when children with severe asthma are present, so that clinicians can check the asthma care plan and understand specific patient needs,” wrote researchers.
In this instance, the health department can maintain a registry of children with severe asthma and link the registry to an app containing a care management plan for each child.
The fifth use case addresses how health departments can use EHR data to assist with medication adherence.
“For identified children who are not receiving a regular prescription for a controller medication, the health department will provide outreach to the families of patients and their primary care doctors to support improved access to therapy,” they wrote.
Finally, public health officials can use EHR data to determine the impact of specific interventions on reducing or improving cases of asthma.
The health department can combine data files from hospitals to assess health trends for different groups of patients including the following:
- Those that live in geographic areas that received specialized interventions compared to those that did not
- Those that were offered case management services compared to those that were not
- Those who have an updated asthma care plan compared to those that did not
The health department can use this information to decide whether to continue with specific intervention efforts or change them.
In addition to these six use cases, researchers also provided information about HIPAA, how to legally share and use health data with public health agencies, and other areas pertaining to data exchange for public health services. Researchers also offered recommendations to public health agencies interested in utilizing EHR data to improve community care.