The ability to identify disease outbreaks and trends early is critical to minimizing their potential impact on public health
From measles and influenza to the Ebola virus, the ability to identify disease outbreaks and trends early is critical to minimizing their potential impact on public health. More so, the wide adoption of electronic health records (EHRs) by healthcare providers, in recent years driven to a large extent by the Meaningful Use incentive program and related regulatory changes, has catapulted disease surveillance to the forefront of healthcare providers’ IT toolbox.
Historically, providers who encounter a reportable disease have had to notify local public health agencies who in turn may collaborate with the Centers for Disease Control and Prevention (CDC) to track the disease outbreak in aggregate. However, this reporting can be a slow process as it requires providers’ to use valuable time filling out large amounts of paperwork that may be transmitted via fax, and then manually processed over days or even weeks. In contrast, EHRs have the ability to capture massive amounts of salient health data without additional effort from providers as they use just one platform to run their entire practice, while performing various tasks ranging from scheduling, billing and charting to ordering labs, imaging and e-prescribing.
All this data, when connected to public health agencies in an efficient, compliant manner, can be analyzed to establish disease outbreak trends and even create predictive models. Most importantly, it can be translated into meaningful and actionable insights for providers at the point of care. One way this can be done is through the use of disease surveillance programs. These types of programs not only help providers treat their patients, but can also help them keep local patient populations from ever becoming sick.
Successful Surveillance Programs
The most successful disease surveillance programs provide actionable insights that empower and strengthen the relationship between patients and providers.
Take, for instance, the Zika virus outbreak that swept through Latin America and has now reached certain areas of the United States. We see in the news almost daily new outbreak trends of the virus in Florida and other states, along with updated numbers of pregnant women who have become infected with the virus. Yet, we must ask if the way we are currently conducting disease surveillance is really providing the actionable insights we need to improve care and strengthen the provider-patient relationship.
Practice Fusion, utilizing its cloud-based EHR, recently surveyed providers about their perceptions and knowledge of the Zika virus in their daily practice and found that:
- Three in four providers are looking for more information on the subject for their patients and their practice.
- Nearly half of respondents receive questions concerning the Zika virus from their patients more than a few times a month, particularly in Southern states.
- Roughly a quarter of the clinicians who responded to the survey felt confident in correctly identifying Zika symptoms, testing protocols, and symptom management.
This clearly indicates that providers need more information to help their patients. Responding to survey results, researchers leveraged a de-identified clinical database, which includes more than 38 million records, representing 6.7% of all practices across the United States, to identify where the majority of Zika diagnoses were being documented on the platform. Links to relevant information from the CDC were then delivered to providers for their practice and patients directly through the EHR workflow. These materials included information on mosquito prevention for patients at home, symptom identification, testing protocols, and guides to alleviating symptoms of the virus, among other topics.
Besides providing informational resources where it matters, disease surveillance has the capacity to be more actionable.
For instance, EHRs can leverage available evidence-based guidelines and data to develop clinical decision support alerts, which are notifications delivered to providers in their EHR that a specific action may be appropriate for a patient. Clinical decision support alerts can be used to alert providers when there is a gap in care for a particular patient, such as missing a certain vaccine or a potential disease outbreak, and provide guidance on testing and screening protocols.
A recent program, for example, aimed to improve public outcomes by leveraging clinical decision support to alert providers if a patient was missing a vaccine via a cloud-based EHR. The program included over 20,000 healthcare providers and recorded visits involving patients over the age of 18. Researchers observed a 73% relative increase in recorded vaccinations after comparing the pre- and post-initiation periods of the program.
Data gathered from disease surveillance can then be used to measure outcomes of interventional and preventative initiatives.
In evaluating the success of a disease surveillance program, important questions must be answered. Were established predictions or predictive models accurate? When clinical guidelines were followed, was one treatment more efficacious than the other? Were the screening and testing protocols a positive indicator for disease prevention? What were the outcomes of patients that were treated after exposure versus those where exposure was prevented?
All of these critical questions can be answered retrospectively, and even prospectively, with de-identified data from EHRs, thereby providing a unique observation into real world practice and care.
Disease surveillance has proven to be a critical tool to public health for decades. Further, the focus on EHR adoption in recent years has helped to augment the amount of data that agencies and researchers are able to capture and analyze. In turn, this has allowed agencies and researchers to provide even more accurate and efficient analyses of public health and disease trends. However, current techniques provide only a macro-level view of potential health trends and predictions.
Healthcare providers need a more personalized approach to help prevent disease and more effectively treat their patient populations.
Cloud-based EHRs offer a unique capability, when compared to on-premises or server-based systems, to leverage data in real time and notify providers at the point-of-care about a potential action that may be appropriate for a patient. In essence, a more personalized approach to healthcare will enable providers to move patients from sick to well faster, and achieve the “Triple Aim” – quality care, population health, and reducing cost.
About the Author
Richard Loomis, MD, is the vice president and CMO of Practice Fusion where he leads the health informatics and research teams. He currently serves as co-chair of the HIMSS Electronic Health Record Association’s (EHRA) Executive Committee and is actively involved in the health IT community working to advance health data interoperability. Loomis completed his fellowship in biomedical informatics at Harvard and received his MD from the University of Michigan.