Assessing the potential of national strategies for electronic health records for population health monitoring and research

Assessing the potential of national strategies for electronic health records for population health monitoring and research.

(Friedman DJ. Assessing the potential of national strategies for electronic health records for population health monitoring and research. Vital Health Stat 2. 2006 Jan;(143):1-83.)

Introduction

Public health stands to gain significantly from the wide spread adoption of electronic health records. The secondary use of electronic health record data for population health monitoring and research is assessed and discussed within the context of national strategy development. The study was commissioned by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

Question

What is the current state and future potential of national strategies for utilizing electronic health record data for public health monitoring and research?

Objective

The study was designed to assess the potential impact of electronic health records on the collection of population health statistics and the role of national strategies in advancing this secondary use of electronic health data. Health statistics, for this study, are measurements of the population’s general health usually attained by registries, administrative health data and population-based surveys. This study did not evaluate the use of electronic health records for disease, syndrome or bioterrorism surveillance. The current status of national strategies regarding the use of electronic health records for public health monitoring and research were evaluated from Australia, Canada, England and New Zealand.

Data were collected from reports, presentations, web pages, articles and interviews with experts. The utilization of electronic health records for population monitoring and research is presented with regards to the following areas: current status, future plans, allocation of responsibilities, infrastructure, storage, confidentiality concerns, patient identification and participation. The potential contributions from electronic health records to public health are described and fundamental issues and barriers are discussed. A summary of factors limiting the use of electronic health records and factors with potentially positive influence are presented for consideration during the development of national strategies for the use of electronic health records in population monitoring and research.

Results

National strategies for public health uses of electronic health records are in various, early stages of development. England has conceptualized, designed and implemented a national strategy which resulted in the establishment of the National Health Service Secondary Uses Service dedicated to providing higher quality data for public health policy and planning. Both Australia and Canada are conducting local pilot tests and New Zealand is in the process of conceptualizing a national strategy for utilizing electronic health records for population monitoring and research.

Critical issues for consideration during the development of a national strategy include: how the national strategy should support public health, determination of parameters for patient participation and confidentiality, and harmonizing standards for clinical data and population health and monitoring data. The emerging potential contributions from electronic health data to public health monitoring include the ability to track people moving through the healthcare system, performance measurement at individual and intuitional levels, baseline population data for research purposes and the elimination of distinctions between public health data and individual clinical data sets.

Conclusions

The use of electronic health records for public health analysis is currently limited by several factors. Public health data must have a denominator (representing the population) and a numerator (representing events) which is drawn from the denominator. To attain such information for public health monitoring and research, electronic health records must completely penetrate the geographic area from which the population is selected and professional standards for data structure, completeness, and quality must be established.

A unique patient identifier must be applied and issues surrounding patient consent could compromise the data set. The study suggests several factors which may facilitate the successful implementation of a national strategy including: government funding for healthcare, a high percentage of the population insured, and the centralized coordination of healthcare. Other pivotal threshold factors include: requiring the structuring and standardizing data, setting clear data rules and definitions, and the linking of data to a unique patient identifier.

Commentary

The results of this study are most useful to public health clinicians, public health researchers, information technologists and government policy makers. The issues of data harmonization, standards and privacy are not unique to the secondary use of electronic health record data for population health monitoring and research but are found throughout the field of health care informatics. National strategies for population health monitoring and research using electronic health records will be key in advancing the utilization of electronic health records for public health however significantly more research is needed.

Dani Przychodzin