The use of electronic health records could be improved in the public health arena with an "innovation layer" application placed over the existing health IT structure, according to an article in the Journal of the American Medical Association (JAMA).
The article, by Kenneth Mandl, M.D., a professor at Harvard Medical School and chairman in bioinformatics and population health at Boston Children's Hospital, points out that public health officials still contact clinicians through traditional dispatches and media alerts, and that public health remains mostly locked out of the point of care.
"The United States has purchased an infrastructure that shows a clinician one patient at a time, emphasizing the information previously entered in the EHR," Mandl (pictured) says. "The vast population data accumulating in EHRs are not yet brought to bear on individual clinical decision making, nor are the 'big data' available from across the health ecosystem. Public health data resources--in this case, for example, geomapped Ebola incidence that could be used in a clinical decision support system to update the prior probability that a patient is at risk--are separated from the care process."
To that end, Mandl says that patients "deserve the improved diagnosis" that contextual awareness would create. "Physicians deserve public health data delivered just in time, targeted to the patient at hand, that will protect them and their patients," he writes.
Mandl suggests that the Centers for Disease Control and Prevention could distribute an app to emergency departments regarding public health issues such as the Ebola epidemic. The app could be added to or deleted from an EHR, using "Substitutable Medical Apps and Reusable Technology" (SMART), which already is being used elsewhere via the Office of the National Coordinator for Health IT's SMART platforms project. The SMART platform, funded with a grant from ONC, originated in 2009.
Next steps could include standardizing a program interface between data and apps, creating functionally, liberating data for diagnosis and readying the point of care.
It has been acknowledged that the public health component of EHRs is not as strong as it could be. Many public health registries and agencies can't even receive electronic information from providers yet, a requirement of the Meaningful Use program. The Centers for Medicare & Medicaid Services created a database to identify which public health entities are ready to receive this data.
To learn more:
- read Mandl's article