CHCs and Public Health HIT Partnerships – The New York Experience (addressing common goals, clinical decision support, public health reporting, public health alerts, syndromic surveillance) Joseph Lurio, MD IFH Winfred Wu, MD, MPH NYC DOHMH

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CHCs and Public Health HIT Partnerships The New
York Experience (addressing common goals,
clinical decision support, public health
reporting, public health alerts, syndromic
surveillance)Joseph Lurio, MD IFHWinfred Wu,
MD, MPH NYC DOHMH
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The Institute for Family Health

• 15 Community Health Centers
• Bronx, 4 Manhattan,
• 6 Mid-Hudson Valley
• 8 homeless healthcare sites
• 1 School based health programs
• 3 Dental centers
• 2 Community Mental Health Centers
• 2 Free Clinics
• 225,000 primary care visits
• 70,000 patients

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NYC DOHMH

• Serves all five boroughs of NYC
• Six Major Divisions
• Disease Control
• Environmental Health
• Epidemiology
• Health Care Access and Improvement
• Health Promotion and Disease Prevention
• Mental Hygiene
• Staff of 6,000

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Center of Excellence in Public Health Informatics
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Project Partners
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Goals of Collaboration

• Improve Function of EHR
• Demonstrate How CHCs can be integrated into
  Public Health Infrastructure

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Collaborative Projects

• Center of Excellence (2004)
• TCNY
• Syndromic Surveillance
• Immunization Interface (Bidirectional) (NYCDOHMH
  IFH)
• Medlee natural language processing data
  extraction project (Columbia)

• New Projects
• (2008 - )
• Reportable Disease Notification
• Real Time, Alerts
• Swine Flu Surveillance
• SSTI (Appropriate Skin Infection Treatment)
• Urine Antibiograms (Appropriate UTI Treatment)

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Syndromic Surveillance

• Health-related data preceding diagnosis (e.g.
  clinical notes, absentee rates, pharm sales) to
  ID potential cases
• Changes in signal may herald outbreaks

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Syndromic SurveillanceMonitor for

• Influenza Like Illness (ILI)
• GI illness
• Data Utilized
• Chief Complaints
• Diagnoses (filed by provider)
• Vital Signs
• Temp
• Pulse
• BP
• Resp
• Orders

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Syndromic Surveillance ILI (Broad Definition)
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Two plots of IFH ILI visits defined by CC of
fever vs MT gt 100
NYC ED syndromic surveillance CC based
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Take Care New York (TCNY) Goals

• Have PCP
• Healthy Heart
• Diabetes Mellitus BP/LDL/A1c
• Cardiac Patients BP/LDL
• Cancer Screening
• Mammo
• Cervix
• Colorectal
• Diabetes Screening
• Hypertensives
• Hyperlipidemics
• HIV Screening

• Substance Use
• Assessment (Tobacco, Alcohol, Drugs)
• Smokers Taking meds
• Smoker Quit Rate
• Buprenorphine Treatment
• Obesity
• BMI Assessment
• Obesity Treatment
• Depression
• Screening
• Reassessment (Treatment)

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Strategy for Achieving TCNY Objectives
Integration into Clinical Workflow

• Alert Clinical Best Practice Alerts (BPAs)

• Assist Hyperlinked order sets (SmartSets)

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Example SmartSet
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Percentage of Women ages 52-69 that Received a
Mammogram
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Immunization Registry Interface
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Immunization Interface NYC CIR
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Immunization Interface Epic
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Immunization Interface Was it worth all that
effort?

• Lots of Work to Build
• Lots of Work to Maintain

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Integrating Public Health Alerts at the Point of
Care
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Rapid Response To Emerging Conditions

• Objectives
• Decrease time to diagnosis
• Opportunity for clinician to identify and treat
  rare conditions quickly
• Increase chances for containing an epidemic

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Current State of Public Health Information
Exchange

• Health Alert Network (HAN)
• MMWR
• Mass media
• Peer-reviewed literature
• Problem Information not integrated into clinical
  workflow

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Delivery of Public Health Information via EHRs

• Enables
• Integration of information in the clinical
  workflow
• Delivery of information in a specific and
  contextually relevant manner
• Collection of additional
• Patient history
• Diagnostic tests
• Up to date treatment (Via guideline transmittal
  Linked Order Sets)

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Alert for Swine Flu
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Decision Support

• Public Health Notices (HPN) - Good
• Best Practice Alerts - Better

• It was a dark and stormy night.
• Dr. Lurios clinic was supposed to be over at
  5PM, but at 6 his nurse told him there was one
  more patient to be seen

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Notifiable Disease Reporting

• Health providers mandated to report notifiable
  conditions
• Reporting in NYC via paper or internet (web-form)
• Historically low compliance by providers
• Lack of awareness
• What to report
• How to report
• Time

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Improving Reporting With EHRs

• EHRs can facilitate provider reporting
• Notify provider when to report
• Provide forms for reporting
• BPA configured with hyperlinked reporting form

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Initial Results
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Initial Results
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• Of the 34 patients where provider documented plan
  to report, only 6 were received at DOHMH!

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Next steps Prepopulated forms specific to
condition being reported
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H1N1 Surveillance Project Using IFH/DOHMH
partnership

• Opportunity to address
• Proportion of ILI due to H1N1 swine influenza
• Frequency of severe illness
• Differences between mild and severe illness

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H1N1 Surveillance Project

• Community surveillance project began on 5/26
• Key partners
• IFH
• DOHMH
• Columbia University
• Value to public health and clinical community

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H1N1 Surveillance Project

• Results to Date
• 114 patients tested since 5/26
• 61 (54) positive for H1N1
• Sensitivity of rapid test 28 (17/61)

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Collaboration between DOH and CHC provides mutual
Benefit

• DOH Requires Ambulatory Practices to act as eyes
  and arms
• CHCs rely on DOH to provide expert guidance and
  situational awareness to allow effective health
  care delivery
• Electronic Health Records are a communication
  tool that allows this collaboration to occur.

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Special thanks to
Frances Morrison2, Rachel Berg1, Michael Buck2 ,
Winfred Wu3, Kwame Kitson1 Farzad Mostashari4 ,
Neil Calman1 1 Institute for Family Health 2
Columbia University 3 New York City
Department of Health and Mental Hygiene 4-
Office of the National Coordinator for Health IT

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Contact information
Joseph Lurio, MD, FAAFPChief Medical Information
OfficerInstitute for Family HealthEmail
jlurio_at_institute2000.org
Winfred Wu, MD, MPHNew York City Department of
Health and Mental HygieneEmail
wwu2_at_health.nyc.gov