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 theInstitute 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. 1 It is Impossible to DeliverState-of-the-artHealth Care without an EHR

4. 2 Community Health Centers are a Vital Part of our Nation’s Public Health System

5. t Release 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. Patient Address Race / Age / Gender Medical history Provider Location Reason for visit Problem list Temperature Height/weight Respirations Procedures Medications Lab results Diagnoses Single patient visit yields complex EHR data

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 >100 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. 3 Community Health Centers can expand knowledge about the community’s 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 < 18 yo, cough/fever requests provider to do full cultures and call DOH for immediate pick-up and ID by DOH lab => message in EHR supports Dx of future pts Cough

13. 4 Few Measurable Quality Improvements Come from EHRs –Almost All are Facilitated by EHRs and Cost Real $$$$$

15. Clinical Decision Support – Impact on Vaccines

16. HgbA1c Progress

18. 10 Take New York Indicators • Have a Regular Doctor or Other Health Care Provider • Be Tobacco-Free • Keep Your Heart Healthy • Know Your HIV Status • Get Help for Depression • Live Free of Dependence on Alcohol and Drugs • Get Checked for Cancer • Get the ImmunizationsYou Need • Make Your Home Safe and Healthy • 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 >35; Women>45 Who have had their cholesterol tested

22. Men >35; Women>45 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 >65yrs old

28. Pneumococcal Vaccine >65yrs old

29. Provider Nutritionist Referral Rate vs. Pts Average HgBA1c 22 1 0.9 9 12

30. 5 New opportunities emerge to get information about racial disparities in health outcomes

31. Last Hemoglobin A1c by Race

33. 5 Power to the People

38. What will the future bring …?

39. Its just the beginning …..