LETTERS HEALTH INFORMATION TECHNOLOGY AND THE PRIMARY CARE INFORMATION PROJECT In their recent article, Friedman et al. lay the groundwork for a discussion of how local health departments could unlock the potential of health information technology (HIT) to benefit public health.1 We concur and also want to point out that several public health agencies are already using HIT to enhance population health. For example, the New York City Department of Health and Mental Hygiene (DOHMH) Primary Care Information Project (PCIP) is already leveraging clinical HIT systems to promote integration of primary care and population health.2,3 PCIP assists more than 9000 clinicians, mainly in low-income communities with high proportions of Medicaid-insured and uninsured patients, adopt electronic health records (EHRs) and achieve meaningful use standards for the federal EHR Incentive Program.4 In 2011, PCIP created the Hub Population Network (the Hub) to collect and analyze aggregate data from the EHRs of affiliated providers, thus making these data available for quality improvement initiatives5: as of October 2013, approximately 620 New York City practices, together serving

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more than 1.5 million patients annually, report data on the Hub (Figure 1). Despite the challenges outlined by Friedman et al.,1 the city’s health department programs already use EHR data for analysis of trends in population health indicators including HIV testing, influenza vaccination of high risk groups, body mass index, and contraceptive coverage. DOHMH is creating a municipal EHR-based surveillance system, the NYC Macroscope, covering key measures of morbidity; in 2014, DOHMH and City University of New York School of Public Health will validate the system against a gold standard examination survey to

understand which EHR-based indicators perform best and which populations are represented well.6 HIT can be harnessed for public health surveillance of reportable and emerging diseases and improvement in the quality of preventive care7,8: among practices that implemented EHRs, increases of five or more percentage points per year are seen across several quality of care measures, including blood pressure control. Use of clinical data for population surveillance alone will not improve health. Providers, especially those in small, independent primary care practices, require extensive technical

No. of PCIP patients 5000–14 999 15 000–24 999 25 000–34 999 35 000–44 999 ≥ 45 000 Practice distribution 1 practice

Note. The sample was n = 630 PCIP practices representing n = 1 628 136 patients. Inclusion criteria were a New York City zip code and a visit in 2012. Data were collected by PCIP using the Hub Population Health System, October 22, 2013.

FIGURE 1—Primary Care Information Project (PCIP) Hub Population Network coverage: New York City, 2012.

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assistance to achieve increased delivery of clinical preventive services.9 By placing a local public health department in the position to provide such assistance, we help ensure that the dual goals of improving clinical care and population health can be reached. j Katherine Kaye, MD, Jesse Singer, DO, Remle Newton-Dame, Sarah C. Shih,

MPH MPH MPH MPH

About the Authors At the time the work was conducted, all authors were affiliated with the Primary Care Information Program, New York City Department of Health and Mental Hygiene, New York, NY. Correspondence should be sent to Katherine Kaye, MD, MPH, Primary Care Information Program, New York City Department of Health and Mental Hygiene, 2 Gotham Center, 42-09 28th Street, 12th Floor, Long Island City, New York, 11101 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted November 10, 2013. doi:10.2105/AJPH.2013.301787

Contributors All authors reviewed the article by Friedman et al., conceptualized points that needed to be covered in the response, and reviewed drafts of the response.

8. DeLeon SF, Shih SC. Tracking the delivery of prevention-oriented care among primary care providers who have adopted electronic health records. J Am Med Inform Assoc. 2011;18(suppl 1):i91---i95. 9. Ryan AM, Bishop T, Shih SC, Casalino LP. Small physician practices in New York needed sustained help to realize gains in quality from use of electronic health records. Health Aff (Millwood). 2013;32(1):1---11.

FRIEDMAN AND PARRISH RESPOND We thank Kaye et al. for their helpful comments on our article. As they indicate, the New York City Department of Health and Mental Hygiene’s Primary Care Information Project, its Hub Population Network, and the associated NYC Macroscope are accomplishing three key steps in utilizing electronic health records for public health intervention and population health information: (1) collecting essential indicators from patients, (2) aggregating those indicators at the population level, and, especially encouraging, (3) validating the representativeness of the collected data at the population level. We congratulate Kaye and her colleagues, and we look forward to reviewing the results of their efforts. j Daniel J. Friedman, PhD R. Gibson Parrish, MD

References 1. Friedman DJ, Gibson P, Ross DA. Electronic health records and US public health: current realities and future promise. Am J Public Health. 2013;103(9):1560--1567. 2. Frieden TR, Mostashari F. Healthcare as if health mattered. JAMA. 2008;299(8):950---952. 3. Institute of Medicine of the National Academies. Primary care and public health: exploring integration to improve population health. 2012. Available at: http:// www.iom.edu/Reports/2012/Primary-Care-and-PublicHealth.aspx. Accessed December 18, 2013. 4. Office of the National Coordinator for Health Information Technology. Regional Extension Centers. Available at: http://www.healthit.gov/providers-professionals/ regional-extension-centers-recs. Accessed December 18, 2013.

About the Authors The authors are with Public Health Informatics Institute, Decatur, GA. Correspondence should be sent to Daniel J. Friedman, PhD, 12 Gorham Ave, Brookline, MA 02445 (e-mail: friedman. [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted November 17, 2013. doi:10.2105/AJPH.2013.301807

Contributors The authors contributed equally to this letter.

5. Buck MD, Anane S, Taverna J, Amirfar S, StubbsDame R, Singer J. The Hub Population Health System: distributed ad hoc queries and alerts. J Am Med Inform Assoc. 2011;19(e1):e46---e50. 6. McVeigh KH, Newton-Dame R, Perlman S, et al. Developing an electronic health record-based population health surveillance system. New York City Department of Health and Mental Hygiene. 2013. Available at: http://www.nyc.gov/html/doh/downloads/pdf/data/ nyc-macro-report.pdf. Accessed December 18, 2013. 7. Shih SC, McCullough CM, Wang JJ, Singer J, Parsons AS. Health information systems in small practices: improving the delivery of clinical preventive services. Am J Prev Med. 2011;41(6):603---609.

March 2014, Vol 104, No. 3 | American Journal of Public Health

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Health information technology and the primary care information project.

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