Redesigning electronic health record systems to support public health.

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Redesigning electronic health record systems to support public health.

Rita Kukafka , Jessica S Ancker , Connie Chan , John Chelico , Sharib Khan , Selasie Mortoti , Karthik Natarajan , Kempton Presley , Kayann Stephens J Biomed Inform. 2007 Jul 9;

First Review

This article discusses the following question: Why current electronic health record systems need to be redesigned to better support public health goals and core functions (assessment, policy development, assurance). Current EHR systems are clinically oriented. Identification and discussion of design, implementation, and methodological issues.Current EHR systems focus on the individual patient care provided by clinicians. Recommendations are provided for changes to current EHR systems will benefit public health but also provide benefits to consumers and health care providers. The needs of public health are not met by the current clinically focused EHR systems. Changes in these EHR systems would benefit but also pose challenges to a number of stakeholders. Two broad suggestions are offered: reuse of clinical data for public health purposes and expansion of the clinical data model to collect and process public health data such as psychosocial, behavioral, and environmental variables. The article identifies a third issue as outside the scope of this discussion (privacy and security protections). The authors offer specific suggestions for expanding the current clinical model (to better reflect and address public health core functions) using informatics methods.

As discussed by Kukafka and colleagues, in order to serve public health needs current (and by implication) future electronic health record systems should be redesigned. The authors identify specific public health data collection and reporting requirements that are not routinely met by current EHR systems. If EHR systems are modified, public health might be able to reduce the amount of reportable data collection that is currently conducted via surveys and paper-based processes, thus reducing the amount of redundant or duplicate data reporting by clinicians. The authors’ suggestion that “data should be collected once and only once” seems sensible but idealistic given the current complex health system and the diversity of data user needs and specifications. However, the authors make a good case for relooking at the data that are currently collected and proposing that current standards and data modeling efforts be enhanced to better address the (increasing) needs of public health. The authors pose relevant arguments that benefits would accrue to clinicians and public health by incorporating 2 major changes to current EHR systems (more reuse of currently collected data and collection of new data).

reviewed by Meryl Bloomrosen

Second Review

Introduction- This article focuses on how EHRs (also known as EMRs) can be designed to help achieve the core functions of public health, which are: Assessment, Policy, and Assurance. It states that EHRs are mostly focused on the clinical aspects of care, and not on the socio-behavioral or economic. The authors examine ways that EHRs can be designed to assist with public health duties without intruding on the clinician’s workflow.

Methods- The article is divided into sections, one for each core function of public health. Assessment: The sharing of data directly from EHRs to public health agencies would allow almost real-time collection of data and alleviate the paperwork that physicians must complete for disease reporting. Policy: With better data available, the public can be better informed and the best decisions can be made regarding what actions to take (policy) concerning the data results. Assurance: Providing EHRs to clinics and patients which are located in underserved areas will help ensure the continuity of care of the patients.

Conclusion- The authors conclude that designing EHRs to better accommodate public health duties has benefits for all stakeholders. However, they also acknowledge that such a task will have its difficulties and require time.

My comments- This article was published in 2007, when EHRs were significantly less implemented than they are today and their functions were still analyzed and debated. I like the idea of an EHR which is more suited for public health duties, and hopefully this will become a reality in the near future.[1]

reviewed by Alexandra Zingg

Additional comments

This has obvious benefits that it reduces the work associated with reporting requirements and as well as has the potential of increased reporting hence allowing for better data. These EHR should not only be able to take care of the present requirements but also should be easily modifiable for the future needs. For diseases that do not require patient specific information how would the patient privacy be maintained?


  1. Kukafka, R., Ancker, J.S., Chan, C., Chelico, J., Khan, S., Mortoti, S.,..., Stephens, K.(2007). Redesigning electronic health record systems to support public health. Journal of Biomedical Informatics, 40(4)398-409.