title: Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience.
abstract: BACKGROUND
  Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way.
  
  
  METHODS
  In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor.
  
  
  RESULTS
  From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it.
  
  
  CONCLUSIONS
  Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health.
authors.affiliation: Primary Care Information, Project New York City, Department of Health and Mental Hygiene 42-09 28th St, 12th floor, Long Island City, NY 11101, USA. samirfa1@health.nyc.gov
authors.forename: Sam
authors.initials: S
authors.lastname: Amirfar
authors.forename: John
authors.initials: J
authors.lastname: Taverna
authors.forename: Sheila
authors.initials: S
authors.lastname: Anane
authors.forename: Jesse
authors.initials: J
authors.lastname: Singer
mesh_terms: D003153:Community Health Services; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D006801:Humans; D009519:New York City; D010045:Outpatients; D011634:Public Health; D012985:Software Design