HIT: Replacing the Missing Link Between Community Health Care and Public Health Neil S. Calman, MD The Institute for Urban Family Health New York City.

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Presentation transcript:

HIT: Replacing the Missing Link Between Community Health Care and Public Health Neil S. Calman, MD The Institute for Urban Family Health New York City

About the Institute for Urban Family Health Institute for Urban Family Health –11 Community Health Centers – –7 in Bronx, 3 in Manhattan, 6 in Mid-Hudson Valley –8 homeless healthcare sites in Manhattan –2 School based health centers –2 Family Practice Residency Training programs –250,000 primary care visits / 105,000 patients Fully paperless since September 2002 Epic (Verona, Wisconsin) EHR / PMS

It is Impossible to Deliver State-of-the-art Health Care without an EHR 1

Community Health Centers are a Vital Part of our Nation’s Public Health System 2

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

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

Flu isolates Blue = ER “flu/fever” Red = Flu “A” isolates Violet = Flu “B” isolates

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

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

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

Community Health Centers can expand knowledge about the community’s health and use that information to improve its care of patients 3

DOH receives signal of outbreak of respiratory illness Practice Alert in EHR for age message in EHR supports Dx of future pts Cough

Few Measurable Quality Improvements Come from EHRs – Almost All are Facilitated by EHRs and Cost Real $$$$$ 4

Clinical Decision Support – Impact on Vaccines

HgbA1c Progress

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

Clinical Decision Support – Tobacco Best Practice Alert

Patients Seen at Least Once by Their Primary Care Provider

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

Depression Screen with PHQ2

Recorded Substance Abuse Hx

Pneumococcal Vaccine >65yrs old

Provider Nutritionist Referral Rate vs. Pts Average HgBA1c

New opportunities emerge to get information about racial disparities in health outcomes 5

Last Hemoglobin A1c by Race

Power to the People 5

What will the future bring …?

Its just the beginning …..