Impact of integrating public health clinical decision support alerts into electronic health records on testing for gastrointestinal illness.

Laboratory testing by clinicians is essential to outbreak investigations. Electronic health records may increase testing through clinical decision support that alerts providers about existing outbreaks and facilitates laboratory ordering. The impact on laboratory testing was evaluated for foodborne disease outbreaks between 2006 and 2009. After controlling for standard public health messaging and season, decision support resulted in a significant increase in laboratory testing and may be useful in enhancing public health messaging and provider action.

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

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.

Using information technology to improve health quality and safety in community health centers.

PROBLEM: Community health centers (CHCs) face a unique set of challenges and can learn much from each other as they prepare for the adoption of health information technology (HIT). PURPOSE: This paper presents a research agenda aimed at providing information CHCs will need to successfully implement HIT. KEY POINTS: Community health centers must be able to evaluate whether an investment in HIT is the best way to achieve improvements in health outcomes for their communities given the limited resources and high demands they face. Community health centers need better information to guide them in selecting and implementing information technology that will result in improved health quality and safety. Guidance in optimal use of the system, particularly in the effective use of data made available through electronic health records, is needed to realize health care goals. Community health centers need to be active participants in HIT developments in their communities to ensure that their patients benefit from technological advancements that improve health care.