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School and Program Updates

School and Program Updates

CUNY Works with the NYC Health Department to Develop and Validate a New Surveillance System using Electronic Health Records

The New York City (NYC) Macroscope – developed in 2013 by a team of researchers from the NYC Health Department and CUNY School of Public Health– makes use of data from primary care Electronic Health Records (EHR) throughout NYC to track the prevalence of chronic conditions and risk factors, such as hypertension, smoking, obesity, and diabetes. The NYC Macroscope offers timely, reliable information about New Yorkers’ health, which can be used to help make the city a healthier place to live, work and play.

The NYC Macroscope is based on data from approximately 700,000 New Yorkers aged 20 and older who in the past year visited a primary care practice that transmitted aggregate data to the NYC Health Department’s Primary Care Information Project (PCIP). PCIP retrieves data using the Hub Population Health System (“the Hub”).  Practices on the Hub return total aggregate counts to a secure, centralized site without transmitting any patient-identifiable information. The EHR-based counts are then compiled and statistically weighted to the demographic characteristics of adults in NYC who have seen a primary care provider in the last year.

In 2013, the NYC Macroscope planning document, Developing an Electronic Health Record-Based Population Health Surveillance System, described a selection of health indicators with high public health importance: hypertension, diabetes, cholesterol, obesity, smoking, depression, and influenza vaccination. The NYC Macroscope team then obtained EHR-based estimates for these indicators and compared them to the 2013-14 New York City Health and Nutrition Examination Survey < www.nychanes.org > (NYC HANES 2013-14), a “gold-standard,” population-based examination survey led by the City University of New York School of Public Health and the NYC Health Department.

The findings indicate that certain NYC Macroscope indicators – including the prevalence of obesity, smoking, hypertension and diabetes – are similar to NYC HANES estimates using a range of statistical tests. Indicators that performed less well included influenza vaccination and depression diagnosis. Possible explanations are that influenza vaccination often occurs in pharmacies and workplaces (instead of medical practices) and that depression screening is not routinely carried out by primary care providers. The team further assessed the validity of the NYC Macroscope health indicators by reviewing the medical records from consenting NYC HANES participants who have a primary care doctor with an EHR system. The team then analyzed EHR-based medical charts maintained by nearly 200 primary care providers to assess the accuracy of EHR indicators across multiple EHR platforms. Findings from these analyses are forthcoming.

The NYC Macroscope is part of a larger project, Innovations in Monitoring Population Health, conducted by the NYC Department of Health and Mental Hygiene and the CUNY School of Public Health, with financial support from the de Beaumont Foundation, Robert Wood Johnson Foundation, the Robin Hood Foundation, the New York State Health Foundation and the Centers for Disease Control and Prevention.