Informing policy and programs using EHR data: The New York City experience

Background: The Primary Care Information Project (PCIP) at the New York City Department of Health was established in 2005 to improve clinical preventive care in medically underserved areas through the use of health information technology. In 2011, PCIP developed the Hub Population Health System to provide the agency with real-time information on health-seeking populations. This system receives aggregate data from 700 electronic health records (EHRs) with over 2 million patients.

Objective: To use EHR data to guide local programs and assess health policies.

Methods: PCIP collects data from EHRs and analyzes the information to address policy issues and guide agency initiatives. Only aggregate patient counts are transmitted to PCIP; no protected health information is received. Results are used to investigate screening and treatment trends, enumerate characteristics of care-seeking New Yorkers, and identify practices and neighborhoods that would benefit most from health department programs.

Results: PCIP uses EHR data to guide programming, for example by identifying practices for cardiovascular disease quality improvement support or locating operational practices in hard-hit areas after Superstorm Sandy. Other uses have included: identifying low levels of behavioral screening for depression and alcohol abuse in ambulatory care, showing lack of improvement in Hepatitis C screening in primary care from 2010 to 2013, demonstrating under-reporting of latent TB among young children, and evaluating the effects of the New York State mandatory HIV testing law.  

Discussion: As the interoperability of EHRs increases, opportunities for using EHR data to influence health policy will grow exponentially. Existing networks such as the Hub Population Health System provide examples of how clinical information can contribute to guiding health policies and evaluating effectiveness of existing laws. EHR data provides a valuable way to drive policy because it is cost-effective, available in near real-time, and can help bridge healthcare delivery and population health.