1. 1 Electronic Health Records: What’s in the pot of gold at the end of the rainbow ? Neil S. Calman, MD

2. 2 The Goals…. Improve Quality, Safety, Efficiency and Reduce Health Disparities Increase Engagement of Patients and Families Improve Care Coordination Improve Population and Public Health Ensure Privacy and Security Protections of Personal Health Information

3. 3 ! ! ! Clinical Decision Support 2003 Progression of HIT at the Institute EHR/PMS Implementation 2002 HIE/ Patient Portal 2008 Quality Reporting/ Improvement 2004 EHR = Electronic Health Record PMS = Practice Management System HIE = Health Information Exchange

4. 4 Supporting population based care 1

5. 5 Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors

6. 6 Colon Cancer Risk Scoring

7. 7 Linking to the Nation’s public health surveillance system 2

8. 8 01234567891011121314151617 Release Number of Cases Symptom Onset Severe Illness Days The Benefit of Early Detection of Syndromes t

9. 9 Single patient visit yields complex EHR data Patient Address Race / Age / Gender Medical history Provider Location Reason for visit Problem list Temperature Height/weight Respirations Procedures Medications Lab results Diagnoses

10. 10 EHR Fever Blue = ER “flu/fever” Purple = EHR Fever >100 F Red = Flu “A” isolates Violet = Flu “B” isolates

11. 11 Fever AND respiratory syndrome Blue = ER “flu/fever” Brown = EHR T≥ 100 o and Respiratory Syndrome

12. 12 Institute patient fevers peaked 13 days before ER visits for Fever and Flu – this indicates that health center data may be the first “signal” of an impending epidemic. Patients of the Institute for Urban Family Health Institute fever data responded to Flu B outbreak-ED data did not

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15. 15 Bringing public health information to the point of care in real time 3

16. 16 Practice Alert in EHR for this center only if patient presents with cough – matched to Legionella order set to assist provider in Dx and Tx DOH sends alert to community re Legionella cases in Parkchester community in the Bronx

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21. 21 Developing Clinical Decision Supports over a Broad Range of Measures 4

22. 22 Clinical Decision Support – Impact on Vaccine Administration in Adults

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24. 24 10 Take New York Indicators 1.Have a Regular Doctor or Other Health Care Provider 2.Be Tobacco-Free 3.Keep Your Heart Healthy 4.Know Your HIV Status 5.Get Help for Depression 6.Live Free of Dependence on Alcohol and Drugs 7.Get Checked for Cancer 8.Get the Immunizations You Need 9.Make Your Home Safe and Healthy 10.Have a Healthy Baby

25. 25 Developing the EHR to monitor quality of care across practice sites 5

26. 26 Patients Seen at Least Once by Their Primary Care Provider

27. 27 Men >35; Women>45 Who have had their cholesterol tested

28. 28 Men >35; Women>45 Who have had their cholesterol tested

29. 29 Depression Screen with PHQ2

30. 30 Depression Screen with PHQ2

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33. 33 Recorded Smoking History

34. 34 Recorded Smoking History

35. 35 Pneumococcal Vaccine >65yrs old

36. 36 Pneumococcal Vaccine >65yrs old

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39. 39 Using EHR data to determine primary care practices that are associated with improved outcomes 6

40. 40 Provider Nutritionist Referral Rate vs. Pts Average HgBA1c 22 12 1 9 0.9

41. 41 Using EHR data to elucidate and help eliminate racial disparities in health outcomes 7

42. 42 Last Hemoglobin A1c by Race

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44. 44 Reductions in HgbA1c with Treatment by Race /Language

45. 45 Five-year Cancer (all sites) Survival Rate SOURCE: CDC/NCHS, Health, United States, 2004

46. 46 Life Expectancy at Birth SOURCE: CDC/NCHS, Health, United States, 2004

47. 47 Infant Mortality Rates SOURCE: CDC/NCHS, Health, United States, 2004

48. 48 Age-adjusted death rates for diseases of the heart per 100,000 males SOURCE: CDC/NCHS, Health, United States, 2004

49. 49 Dissemination of Results; Credits

50. 50 Authored Publications Calman NS, Kitson K, Hauser D “Using Health Information Technology to Improve Health Quality and Safety in Community Health Centers”. Journal of Progress in Community Health Partnerships: Research Education and Action.1(1):83-88. Spring 2007 Calman, NS, Golub M, Kitson K, Ruddock C. Electronic Health Records: The Use of Technology to Eliminate Racial Disparities in Health Outcomes. In: Medical Informatics: An Executive Primer. Health Information and Management Systems Society, Chicago, IL. Kenneth Ong, MD, Editor. January 2007.

51. 51 Authored Publications Sengupta S, Calman NS, Hripcsak G. A Model for Expanded Public Health Reporting in the Context of HIPAA. J. Am. Med. Inform. Assoc. 25 June 2008

52. 52 Our work has been featured in a number of publications by others and has been used as the foundation for others to build upon

53. 53 Commonwealth Fund “Quality Matters” May 2006

54. 54 Miller RH and Ward CE Health Affairs Jan-Feb 2007

55. 55 Awards 2007 Public Health Award HIMSS Physician IT Leadership Award 2005 Partner in NYCDOH CDC Center of Excellence in Public Health Informatics Non-profit Excellence Award 2008 Technology and Focus on Mission