BACKGROUND: New opportunities are emerging for public health and health systems to work together to improve the delivery and use of clinical preventive services. This has required state health departments to access new sources of data for measurement of clinical indicators. To support CDC’s 1422 grant, we expanded an existing preventive care measure set to include additional hypertension performance measures. The state worked directly with clinics to collect data extracted from their Electronic Health Records (EHRs) because Minnesota does not have a Health Information Exchange (HIE).
METHODS: A detailed guide was developed to define the patient population and 49 data elements across four domains: hypertension, obesity, tobacco use, and pre-diabetes. Race, ethnicity, language, country of origin, and insurance data was included. Clinics extracted de-identified patient level data for 2015 from their EHR and securely submitted it to the Minnesota Department of Health. Measures of blood pressure (BP) control, undiagnosed hypertension, use of hypertension self-management plans, and referrals to lifestyle change programs were calculated from the data using SAS 9.4. Chi-square tests identified differences in proportions.
RESULTS: Nineteen clinics submitted EHR data representing 58,217 patients aged 18 and older who received primary care services during 2015. Patients with hypertension represented 35.5% of the population. Among patients aged 18-85 years old with a hypertension diagnosis, 75.1% had adequately controlled BP (<140/90). Among adult patients with high blood pressure, 14.4% were undiagnosed. BP control and undiagnosed hypertension improved with age and were best among Medicare beneficiaries. Uninsured and non-Hispanic black patients performed poorest on both measures. Hispanic patients had the highest rate of BP control and white patients had the lowest rate of undiagnosed hypertension. Capacity to develop EHR reports and provide all data elements varied by clinic. Most clinics were unable to provide data on hypertension self-management plans or referrals to lifestyle change programs.
CONCLUSIONS: Data related to hypertension performance measures was collected with mixed success. EHR data has the potential to be a valuable source of information for public health, but there are limitations to accessing it. Without a central repository, like a HIE, health departments must turn directly to individual clinics to acquire this data which increases the resource commitment at the state level. Depending on their technical capacity, reporting infrastructure, and competing priorities, clinics may find it burdensome to extract and difficult to interpret these data. Public health can assist by providing a population health perspective to clinics while interpreting their data.