ESP

The growing use of electronic medical record systems (EMRs) permits efficient re-use of data already being collected by clinicians during routine private practice, offering an unparalleled opportunity to improve public health practice. Information held in EMR systems includes diagnoses, procedures, laboratory tests, and treatment information, as well as patient demographic data. In order to use this valuable information, we propose to develop systems and software, Electronic medical record Support for Public health practice (ESP), to permit secure, simple, robust, bi-directional PHINMS- and HIPAA-compliant communication between public health authorities, clinicians, and EMR systems. ESP will serve three major functions:

1) Completely transparent reporting of conditions where all required information can be extracted from EMRs.

2) Initiation of reporting that triggers an automated query to clinicians if non-extractable information, such as symptom status, is required.

3) Automatic response to electronic queries by health authorities regarding demographic and treatment status of individuals with positive laboratory tests. In addition, we develop new statistical methods for identifying unusual spatio-temporal clusters of reportable conditions. This work will build directly on this group’s accomplishments in developing the CDC sponsored National Bioterrorism Syndromic Surveillance Demonstration Project.

Our initial efforts will focus on improved reporting of sexually transmitted diseases, including gonorrhea, chlamydia, and pelvic inflammatory disease; tuberculosis, including suspected and latent disease, as well as culture negative active disease; Lyme disease; and asthma. We will formally compare the completeness of reporting of gonorrhea and chlamydia to existing methods that rely on clinicians' paper-based reports plus electronic laboratory reports.  We will develop ESP using the EpicCare EMR of Harvard Vanguard Medical Associates, a pioneer in the use of EMRs, and our team includes collaborators from the Massachusetts Department of Public Health. However, ESP will employ existing widely-adopted standards, and will be specifically designed to be readily re-configured to match a wide array of other commercial EMRs and public health systems, in order to ensure the widest possible applicability.