title: Redesigning electronic health record systems to support public health.
abstract: Current electronic health record systems are primarily clinical in focus, designed to provide patient-level data and provider-level decision support. Adapting EHR systems to serve public health needs provides the possibility of enormous advances for public health practice and policy. In this review, we evaluate EHR functionality and map it to the three core functions of public health: assessment, policy development, and assurance. In doing so, we identify and discuss important design, implementation, and methodological issues with current systems. For example, in order to support public health's traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical data elements, and workflow would have to be examined to determine the optimal way of collecting these data. We also argue that redesigning EHR systems to support public health offers benefits not only to the public health system but also to consumers, health-care institutions, and individual providers.
authors.affiliation: Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, 622 W. 168th Street, Vanderbilt Clinic VC5, New York, NY 10032, USA. ita.kukafka@dbmi.columbia.edu
authors.forename: Rita
authors.initials: R
authors.lastname: Kukafka
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Ancker
authors.forename: Connie
authors.initials: C
authors.lastname: Chan
authors.forename: John
authors.initials: J
authors.lastname: Chelico
authors.forename: Sharib
authors.initials: S
authors.lastname: Khan
authors.forename: Selasie
authors.initials: S
authors.lastname: Mortoti
authors.forename: Karthik
authors.initials: K
authors.lastname: Natarajan
authors.forename: Kempton
authors.initials: K
authors.lastname: Presley
authors.forename: Kayann
authors.initials: K
authors.lastname: Stephens
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D008490:Medical Informatics / Q000379:methods* / Q000458:organization & administration*; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D009518:New York; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health / Q000379:methods*; D011635:Public Health Administration