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

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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 – PowerPoint PPT presentation

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


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 Hea
lth Care without an EHR
4
Community Health Centers are a Vital Part of our
Nations Public Health System
5
The Benefit of Early Detection of Syndromes
Symptom Onset
Severe Illness

Number of Cases
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

Days
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 gt100
F Red Flu A isolates Violet Flu B
isolates
9
Fever AND respiratory syndrome
Blue ER flu/fever Brown EHR T 100o 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 communitys health and use that
information to improve its care of patients
12
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
13
Few Measurable Quality Improvements Come from
EHRs Almost All are Facilitated by EHRs and
Cost Real
14
(No Transcript)
15
Clinical Decision Support Impact on Vaccines
16
HgbA1c Progress
17
(No Transcript)
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 gt35 Womengt45 Who have had their cholesterol
tested
22
Men gt35 Womengt45 Who have had their cholesterol
tested
23
Depression Screen with PHQ2
24
Depression Screen with PHQ2
25
Recorded Substance Abuse Hx
26
Recorded Substance Abuse Hx
27
Pneumococcal Vaccine gt65yrs old
28
Pneumococcal Vaccine gt65yrs old
29
Provider Nutritionist Referral Rate vs. Pts
Average HgBA1c


22
1
0.9
9
12
30
New opportunities emerge to get information
about racial disparities in health outcomes
31
Last Hemoglobin A1c by Race
32
(No Transcript)
33
Power to the People
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
What will the future bring ?
39
Its just the beginning ..
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