1. 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

2. 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

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

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

5. 01234567891011121314151617 Release Number of Cases Symptom Onset Severe Illness Days The Benefit of Early Detection of Syndromes t

6. 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

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

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

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

10. 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

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

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

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

15. Clinical Decision Support – Impact on Vaccines

16. HgbA1c Progress

18. 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

19. Clinical Decision Support – Tobacco Best Practice Alert

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

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

23. Depression Screen with PHQ2

25. Recorded Substance Abuse Hx

27. Pneumococcal Vaccine >65yrs old

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

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

31. Last Hemoglobin A1c by Race

33. Power to the People 5

38. What will the future bring …?

39. Its just the beginning …..