With the passage of the HITECH Act there is been an ever increasing push towards the use of electronic medical records (EMR). However, public health agencies have generally been slower to adopt for a variety of reasons. Also, their Health IT systems are often more outdated then the ones in the private, non-public sector. However, certain meaningful use rules, such as conducting syndromic surveillance and reporting to immunization registries, ask providers to communicate with public health agencies. Consequently, public health departments are under pressure to re-structure their technology platforms.
Public health has unique workflows which can have major implications for EMR vendors. To understand this it is important to explore how public health is different from medical care in doctors' offices or in hospitals.
1) There is greater emphasis on population screening and treatment, resulting in separate clinics focusing on specific aspects of care provision – providing immunizations, conducting STD screenings, etc. Also, there may be many more staff involved, some of which play roles that are not present in outpatient practice.
2) As part of their mission these organizations normally perform a community assessment at regular intervals. This helps to identify the rates of certain diseases in the community and can guide the deployment of conditions that are more prevalent. As a result the type of visits and demographic make-up of the patient panels can vary greatly over time.
3) The type of data that needs to be tracked is such that epidemiological studies can be readily done on it (ie. incidence, prevalence, etc.).
4) There are certain forms that mandatory to use. One example is the use of Healthy Futures Pediatrics for pediatric physicals.
5) There are unique situations where patients are seen in settings that are not typical for a doctor’s office. For example, a patient that has tuberculosis will be placed on home quarantine. The nurse will go there and obtain sputum samples and treat the patient with none of the interaction taking place in the clinic.
6) Finally, there are specific reporting requirements by the State and Federal Government. This has implications on the type of and amount of data that needs to be collected. Also, there
As a result, the EMR vendor has to:
1) Understand various different workflows, each specific to a particular clinic.
2) Be able to work with a large number of users, some of which play unorthodox roles
3) Incorporate data fields and a format to capture information that can be used for population reporting. The databases that are used should be able to store a large number of data points.
4) Provide access to the EMR through a variety of mobile portals – phones, tablets, etc.
5) Incorporation of or access to certain specific forms.
6) Design reporting engines that can produce reports in a pre-defined format acceptable to the State and Federal Government requirements
7) Ensure their product is highly interoperable and can regularly pass data back and forth from providers and to State Registries and between other organizations.
The EMRs that can successfully support public health needs have an architecture that allows need new programming code to be inserted readily without having to create a new. New features can be added through widgets that make it easier for the user to locate and utilize them.
The revolutionizing of Public Health IT infrastructure is a long-awaited milestone that is soon to pass and will improve the management of population health. Dr. Chawla feels that this a trial period for these organizations.The Meaningful Use initiative has really started the ball rolling. The key is to use the right electronic medical record.
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