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BACKGROUND: In 2010, San Diego received federal funding for two major initiatives that provided an opportunity to leverage existing infrastructure to expand the use of Electronic Health Records (EHR). The goal was to facilitate Body Mass Index (BMI) surveillance (now Healthy Weight surveillance) utilizing an existing component of the San Diego Immunization Registry (SDIR) in coordination with a new regional Health Information Exchange (HIE). By mid-2011, due to delays in HIE development; the County began to explore alternate methods to build the needed technical components for BMI surveillance.
METHODS: This project required development of policies, quality assurance (QA) procedures, technical infrastructure, and analytic methods within a compressed timeframe. It also required working with partner healthcare providers that had competing technical projects, often with greater organizational priorities than public health surveillance. Policies included issuing a Health Officer Order to facilitate data collection and establishment of data use agreements to address privacy concerns. New QA tools were developed by SDIR staff to assess clinic policies on measurement and data entry of required data elements. New HL7 segments were added to existing interface messages for available exchanges prior to the development of an available standard. Existing HL7 interfaces were modified to include new height and weight segments where possible; download protocols were developed for those clinics with limited capacity for electronic transmission.
RESULTS: By July 2012, height and weight data transfer capacity was in place for the initial 12 sites. The sites included six community clinic networks, two large medical systems, and four private medical groups. By mid-2013, the SDIR contained 3.2 million patient records, with newly submitted height and weight data on over 710,000 patients. The initial system overrepresented the low-income population, yet provided an early assessment of BMI differences among population groups.
CONCLUSIONS: Increasing adoption of electronic health records (EHR) systems has provided an ideal opportunity to expand the development of systems to monitor population health. In most cases electronic disease surveillance has successfully modernized older, paper-based reporting systems, but federal, state, and local regulations and reporting requirements predated the development of new surveillance models. While existing systems provide a potential solution for health departments to maximize infrastructure and expand current disease surveillance at minimal cost, rapid implementation can outpace development of regulations and policies which ensure that data collection follows established guidelines, resulting in data of sufficient quality that is useful in monitoring community health.