Electronic Health Records for Real-Time, Local Disease Surveillance

BACKGROUND: Cloud-based health information technologies are an efficient, accurate and rich data source for population health monitoring and research.  More specifically, the design of modern electronic health records (EHR) and billing systems can provide public health officials and medical researchers an up to date view of local, national and seasonal health trends.

METHODS: Automated extracts of claims data, from athenahealth’s database (athenanet) were developed to produce provider level counts of office visits, influenza diagnosis (using ICD-9 codes) and vaccinations (CPT codes). athenanet is the centralized database for athenahealth’s EHR and billing applications.  Because these applications are “single-instance” and “cloud-based”  (i.e. a common web-based application that all clients use), detailed documentation of medical visits are instantly and centrally recorded. This enables real-time or near real-time reporting of disease (and procedure) prevalence and incidence, at any level of geography (e.g. zip, county, state, etc). 

RESULTS: We produced local and national reports of influenza activity that closely paralleled the CDC’s FluView data, for multiple flu seasons, based on 23,000 primary care providers across the United States, who accounted for approximately 1 million visits per week.  While our measure of flu activity (diagnosis of flu) differed from the CDC’s (diagnosis of “influenza like illness”), the results showed identical outbreaks and peaks. The accessibility of the data also allowed us to publish data faster than the CDC and other sources. We have also successfully piloted a partnership with a public health department, and are looking to develop more pilots. 

CONCLUSIONS: Our flu-tracking efforts are a test-case for more general disease surveillance and research. The integration of athenanet’s technology and data provides public health officials and researchers timely access to data that reflects health trends, in ambulatory settings.  This data consists of 50 million lives represented in the claims data and 20 million lives represented in the EHR, across 49 states. Furthermore, combining this population breadth with athenanet’s population health outreach tools (e.g. flu vaccination outreach capabilities within the EHR) allows researchers to generate prospective data, in addition to the retrospective and real-time monitoring data.