Enhancing Capacity for Cardiovascular Disease Surveillance Using Electronic Health Record Data

BACKGROUND: Despite cardiovascular disease (CVD) leading causes of death in the United States, recent efforts to harness clinical electronic health record (EHR) systems for public health surveillance have focused on infectious disease. This relates to public health agencies’ historical role of curtailing outbreaks and few regulations for case reporting of chronic, noncommunicable conditions. Concurrent with the rise of EHR adoption, health care reforms are encouraging providers to practice population health management, where a provider’s patient population is analyzed more holistically. Public health agencies have recognized similarities between clinical population health management and their efforts to surveil and reduce chronic disease. Some state and local jurisdictions have begun to harvest EHR data for CVD surveillance, however resource-constrained agencies often lack the technical infrastructure to replicate these techniques.

METHODS: The Public Health Informatics Institute (PHII) has partnered with the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention (CDC) to pilot novel EHR-based surveillance techniques for CVD. We conducted facilitated system design sessions with state and local public health practitioners and their clinical partners to evaluate interoperability approaches between EHRs and public health surveillance systems. Evaluation questions assessed system surveillance attributes including the availability, representativeness, and accuracy of EHR data for CVD surveillance purposes.

RESULTS: This presentation describes findings from the system design sessions and CVD data formats and information exchange approaches that are feasible for resource-constrained state and local public health agencies. This includes examination of the public heath utility of EHR-generated electronic clinical quality measures (eCQMs), data from health information exchange (HIE) organizations, and clinical population health management tools. Tools resulting from this project will help public health agencies use EHR data for surveillance systems. Limitations of this evaluation include constraints on availability of informants from public health and clinical stakeholder organizations. 

CONCLUSIONS: This project identifies opportunities for scaling EHR-based CVD surveillance nationally at a granularity that informs state and local interventions to benefit communities, practices and patients.  The tools developed from this project recognize variation in informatics capabilities across jurisdictions, long term strategic partnerships with health care providers, and the need to share analysis and reporting responsibilities among jurisdictional stakeholders.