Research Activities, January 2014
Public health may benefit from computer-based clinical decision support
Health Information Technology
A variety of issues needs to be resolved to effectively implement two-way communication between public health officials and clinicians treating patients who may be affected by a public health threat such as a newly discovered contaminant in the water supply affecting neighborhoods near a clinic.
That's the conclusion of a systematic review of the topic by Brian E. Dixon, M.P.A., Ph.D., of Indiana University and the Regenstrief Institute in Indianapolis, and his colleagues. They analyzed 10 papers with sufficient evidence that were published between 2001 and 2011. Of these, four focused on Internet dissemination of public health information through a bidirectional, Web-based health alert network (HAN) and six focused on approaches using electronic health records (EHRs).
The HAN articles discussed use of a Web-based portal to facilitate two-way communication between public health workers who have recognized an emerging public health event and clinicians who can query about whether de-identified cases meet the criteria. The six EHR papers looked at the design and implementation of a communications system that allows alerts (and recommended diagnostic actions) to be incorporated into a hospital or outpatient clinic EHR's clinical decision support (CDS) function, and perhaps provide access to a knowledge base of alerts created by various public health organizations. For instance, in the example of the contaminated water supply, which puts patients at risk of waterborne illness, an alert might suggest ordering stool samples of patients who have gastrointestinal symptoms.
Dr. Dixon and his colleagues conclude that these approaches are promising, but more research is needed on possible information architectures, approaches to semantic and system interoperability, governance (including both the public health and clinical communities), and usability. Specific instances of public health threats dealt with by HAN or EHR CDS are described and referenced by the authors. The review was funded in part by AHRQ (HS20909).
More details are in "Toward public health decision support: A systematic review of bidirectional communication approaches," by Dr. Dixon, Roland E. Gamache, Ph.D., M.B.A., and Shaun J. Grannis, M.D., M.S., in the May/June 2013 Journal of the American Medical Informatics Association 20(3), pp. 577-583.