Using electronic health record alerts to provide public health situational awareness to clinicians

Abstract

Alerting providers to public health situations requires timeliness and context-relevance, both lacking in current systems. Incorporating decision support tools into electronic health records may provide a way to deploy public health alerts to clinicians at the point of care. A timely process for responding to Health Alert Network messages sent by the New York City Department of Health and Mental Hygiene was developed by a network of community health centers. Alerts with order sets and recommended actions were created to notify primary care providers of local disease outbreaks. The process, effect, and lessons learned from alerts for Legionella, toxogenic E coli, and measles outbreaks are described. Electronic alerts have the potential to improve management of diseases during an outbreak, including appropriate laboratory testing, management guidance, and diagnostic assistance as well as to enhance bi-directional data exchange between clinical and public health organizations.

Impact of Integrating Public Health Clinical Decision Support Alerts Into Electronic Health Records on Testing for Gastrointestinal Illness

“…The positive effect of CDS alerts on testing may be related to their ability to deliver information in a contextually relevant manner at the point of care, compared with traditional public health messaging that is typically integrated by providers outside of clinical workflow. 2,15 The order sets associated with the CDS alerts reported here enable providers to quickly order diagnostic tests, and this may also have impacted the positive effects reported here. To our knowledge, no additional cases related to the outbreaks were identified through the testing associated with CDS alerting.…”

“…In addition to the work described here, we have implemented CDS alerts for HAN messages distributed for increased incidence of Legionnaire's disease, increased West Nile virus activity, and others. 2 Clinical decision support may also play a role in guiding providers on the appropriate diagnostic workup of infectious diseases outside the context of an outbreak. Two examples of this are reminding providers of the need to specifically order (1) immunoglobulin M serologic testing when they suspect a case of acute measles and (2) hepatitis C RNA testing for patients positive for hepatitis C antibody but unknown RNA status.…”

“…Specifics on the implementation of CDS alerts for this messaging have been published previously. 2 Although CDS has been shown to improve delivery of preventive care 6,7 and public health reporting of vaccine adverse events by providers, 8 it is unclear whether CDS can increase laboratory testing of GI illness beyond the effects of HAN messaging during an outbreak.…”

“…Clinical decision support (CDS) alerts within electronic health records (EHR) can provide such messages and encourage laboratory testing through integration into routine clinical workflows. 2 The Institute for Family Health (a network of community health care centers in New York State), as part J Public Health Management Practice, 2012 These CDS alerts were designed to appear as a bright yellow alert window that included message text informing providers of the outbreaks and were linked to order sets. Order sets are tools within the EHR that allow providers to order relevant diagnostic tests, medications, and other patient management treatments.…”

The Feasibility of Using Electronic Health Records to Describe Demographic and Clinical Indicators of Migrant and Seasonal Farmworkers

“…8 U.S. providers and patients generally support adoption of EHRs and HIE, 9–11 including among economically disadvantaged groups. 12 Public health researchers have already begun using EHR data for surveillance 13–16 and population studies of infectious disease.…”