title: The theory and application of UW ehealth-PHINEX, a clinical electronic health record-public health information exchange.
abstract: BACKGROUND
  Electronic health records (EHRs) hold the promise of improving clinical quality and population health while reducing health care costs. However, it is not clear how these goals can be achieved in practice.
  
  
  METHODS
  Clinician-led teams developed EHR data extracts to support chronic disease use cases. EHRs were linked with community-level data to describe disease prevalence and health care quality at the patient, health care system, and community risk factor levels. Software was developed and statistical modeling included multivariate, mixed-model, longitudinal, data mining, and geographic information system (GIS)/spatial regression approaches.
  
  
  RESULTS
  A HIPAA-compliant limited data set was created on 192,201 patients seen in University of Wisconsin Family Medicine clinics throughout Wisconsin in 2007-2009. It was linked to a commercially available database of approximately 6000 variables describing community-level risk factors at the census block group. Areas of increased asthma and diabetes prevalence have been mapped, identified, and compared to economic hardship.
  
  
  CONCLUSIONS
  A comprehensive framework has been developed for clinical-public health data exchange to develop new evidence and apply it to clinical practice and health policy. EHR data at the neighborhood level can be used for future population studies and may enhance understanding of community-level patterns of illness and care.
authors.affiliation: Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Box 9988 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA. tguilbert@pediatrics.wisc.edu
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.forename: Brian
authors.initials: B
authors.lastname: Arndt
authors.forename: Jonathan
authors.initials: J
authors.lastname: Temte
authors.forename: Alexandra
authors.initials: A
authors.lastname: Adams
authors.forename: William
authors.initials: W
authors.lastname: Buckingham
authors.forename: Aman
authors.initials: A
authors.lastname: Tandias
authors.forename: Carrie
authors.initials: C
authors.lastname: Tomasallo
authors.forename: Henry A
authors.initials: HA
authors.lastname: Anderson
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Hanrahan
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology*; D057225:Data Mining; D003710:Demography; D057286:Electronic Health Records / Q000191:economics / Q000458:organization & administration*; D040362:Geographic Information Systems; D017048:Health Care Costs; D006801:Humans; D033181:Information Dissemination; D015233:Models, Statistical; D015995:Prevalence; D016730:Program Development; D015397:Program Evaluation; D011634:Public Health; D058996:Quality Improvement; D012307:Risk Factors; D012984:Software; D017216:Telemedicine; D014922:Wisconsin / Q000453:epidemiology