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Toolkit for Planning an EHR-based Surveillance Program

The Surveillance Information Lifecycle

Successfully using information from electronic health records systems (EHR) for public health surveillance requires creating a value case, engaging stakeholders, implementing appropriate technologies, and ultimately using information to improve health.

Try starting your journey through this toolkit with these EHR Toolkit Readiness Indicators to help you identify where you are in the process.

This section provides guidance for constructing a strong value case that can gain buy-in for your new surveillance program from stakeholders inside and outside your agency. It helps you establish the programmatic and cost justification for EHR-based surveillance, which requires describing the health problem, the information needed to address the problem and the benefits that your agency, data suppliers and other community partners will experience. 

Collection of EHR-based information by public health is in its infancy compared to traditional procedures for disease surveillance. Legal and policy clarification authorizing EHR data collection and use must be analyzed in terms of acceptability and appropriateness from the perspectives of policy makers, health care providers, and the general public. 

Creating partnership agreements with health care organizations as data suppliers is a critical and potentially daunting next step. Health care organizations are currently undergoing many areas of transformation, both internally and externally, such as implementing EHRs, transitioning to ICD-10, responding to payment reforms, forming Accountable Care Organizations and other major drivers of change.

Once you create the value case, build the necessary partnerships, and verify legal authority for your EHR-based surveillance program, you can begin the more technical design considerations of the program. A key step is to come to agreement among the partners on which data elements are necessary to meet program goals and expectations. This planning phase also includes assessing how the data will be used and what type of surveillance reports will be generated.

The sharing/exchange of data among clinical and public health entities requires assessing organizations’ technical capabilities and aligning technical approaches to exchange. These assessments need to identify and agree on how data will move from one discrete system to another, or how users in one organization will be able to access or otherwise view information stored by another organization.

After a technical design has been selected, it can then be piloted with select health care entities. As successful pilots and increasing clinical partnerships warrant, implementation can then be expanded to improve jurisdictional representativeness and better inform disease interventions.

New EHR-based public health surveillance approaches might require new techniques for analyzing, visualizing, and reporting information. This could include considering how data can be presented to highlight issues and galvanize action, all while preserving patient privacy. Preparing public health agency staff and partners to evaluate EHR data quality and sustain systems over time will also be important.