Uses of electronic health records for public health surveillance to advance public health

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Public health surveillance conducted by health departments in the United States has improved in completeness and timeliness owing to electronic laboratory reporting. However, the collection of detailed clinical information about reported cases, which is necessary to confirm the diagnosis, to understand transmission, or to determine disease-related risk factors, is still heavily dependent on manual processes. The increasing prevalence and functionality of electronic health record (EHR) systems in the United States present important opportunities to advance public health surveillance. EHR data have the potential to further increase the breadth, detail, timeliness, and completeness of public health surveillance and thereby provide better data to guide public health interventions. EHRs also provide a unique opportunity to expand the role and vision of current surveillance efforts and to help bridge the gap between public health practice and clinical medicine.

First Review

This is a review of the article by Birkhead et al., Uses of electronic health records for public health surveillance to advance public health. [1]

Background and Purpose

Increased adoption of electronic laboratory reporting has improved public health surveillance of infectious disease. Nevertheless, manual processes continue to be used for collection of specific clinical data about reported cases. This article discusses effective use of EHR technology for the advancement of public health surveillance to automate the processes surrounding the capture and analysis of clinical data to establish confirmation of diagnoses, prevalence, risk factors and comorbidities.


Electronic Health Record (EHR) technology has the potential to enhance public health interventions and reduce disparities in quality of care through sharing of timely, complete clinical data. Current routine surveillance methods in the public health arena could be transformed and augmented through automated efficient data aggregation. This would allow assessment of population risk factors, current treatment plans, care practices and outcomes for improvement of public health - not just for mandated reporting of highly infectious diseases, but also for other acute and chronic diseases such as diabetes, cancer, and heart disease. There are, however, many barriers and challenges to be overcome. The targets set by incentive programs to improve EHR adoption have not yet been realized. There is a need for increased standardization of EHR content and communication protocols supporting public health informatics. To support data analytics, EHRs need to be linked to provide reliable, near real-time data exchange through interoperable HIEs (Health Information Exchanges). Ongoing research to develop and maintain effective data analysis algorithms is essential as well as nationally standardized approaches to surveillance practices.


Research on the use of EHR data for public health is scarce. There is a need for collaboration among EHR vendors, providers, HIEs, and public health to define standard use cases for public health surveillance and to develop effective standards-based clinical data exchange for disease reporting, case management and continuity of care.


Collaboration among various departments within state public health agencies would allow achievement of common goals through effective sharing of resources. In Texas, the Regional Health Information Organizations (RHIOs) could be strengthened for increased interoperability as well as network through which state-wide data could be aggregated for public health use. The Department of State Health Services also maintains and operates a Health Services Gateway (a state HIE) to interface with internal and external trading partners.

Related studies

Birkhead, G. S., Klompas, M. D., & Shah, N. R. (2015). Public health surveillance using electronic health records: rising potential to advance public health. Frontiers in Public Health Services and Systems Research, 4(5), 25-32.

Cooper, S. P., Heyer, N., Shipp, E. M., Ryder, E. R., Hendrikson, E., Socias, C. M., … Partida, S. (2014).Community Based Research Network: Opportunities for Coordination of Care, Public Health Surveillance, and Farmworker Research. Online Journal of Public Health Informatics, 6(2), e190.

Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. “Using electronic health record alerts to provide public health situational awareness to cliniciansWeb Site Disclaimers.” J Am Med Inform Assoc. 2010.[1]

ASPE REPORT-The Feasibility of Using Electronic Health Data for Research on Small Populations-September 2013-By: Kelly Devers, Bradford Gray et. Al.[2]

Related Reviews

Redesigning electronic health record systems to support public health.

Syndromic Surveillance Using Ambulatory Electronic Health Records


  1. Birkhead, G. S., Klompas, M., & Shah, N. R. (2015). Uses of electronic health records for public health surveillance to advance public health. Annual Review of Public Health,36(1), 345-359. doi:10.1146/annurev-publhealth-031914-122747.