HIT: Replacing the Missing Link Between Community Health Care and Public Health

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HITReplacing 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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About theInstitute 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

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It is Impossible to DeliverState-of-the-artHea
lth Care without an EHR
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Community Health Centers are a Vital Part of our
Nations Public Health System
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The Benefit of Early Detection of Syndromes
Symptom Onset
Severe Illness

Number of Cases
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Days
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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

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Flu isolates
Blue ER flu/fever Red Flu A
isolates Violet Flu B isolates
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EHR Fever
Blue ER flu/fever Purple EHR Fever gt100
F Red Flu A isolates Violet Flu B
isolates
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Fever AND respiratory syndrome
Blue ER flu/fever Brown EHR T 100o and

Respiratory Syndrome
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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
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Community Health Centers can expand knowledge
about the communitys health and use that
information to improve its care of patients
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DOH receives signal of outbreak of respiratory
illness
Practice Alert in EHR for age lt 18 yo,
cough/fever requests provider to do full
cultures and call DOH for immediate pick-up and
ID by DOH lab gt message in EHR supports Dx of
future pts
Cough
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Few Measurable Quality Improvements Come from
EHRs Almost All are Facilitated by EHRs and
Cost Real
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Clinical Decision Support Impact on Vaccines
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HgbA1c Progress
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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

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Clinical Decision Support Tobacco Best
Practice Alert
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Patients Seen at Least Once by Their Primary Care
Provider
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Men gt35 Womengt45 Who have had their cholesterol
tested
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Men gt35 Womengt45 Who have had their cholesterol
tested
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Depression Screen with PHQ2
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Depression Screen with PHQ2
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Recorded Substance Abuse Hx
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Recorded Substance Abuse Hx
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Pneumococcal Vaccine gt65yrs old
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Pneumococcal Vaccine gt65yrs old
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Provider Nutritionist Referral Rate vs. Pts
Average HgBA1c


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New opportunities emerge to get information
about racial disparities in health outcomes
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Last Hemoglobin A1c by Race
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Power to the People
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What will the future bring ?
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Its just the beginning ..