title: Use of Electronic Health Records and Geographic Information Systems in Public Health Surveillance of Type 2 Diabetes: A Feasibility Study.
abstract: BACKGROUND
  Data routinely collected in electronic health records (EHRs) offer a unique opportunity to monitor chronic health conditions in real-time. Geographic information systems (GIS) may be an important complement in the analysis of those data.
  
  
  OBJECTIVE
  The aim of this study was to explore the feasibility of using primary care EHRs and GIS for population care management and public health surveillance of chronic conditions, in Portugal. Specifically, type 2 diabetes was chosen as a case study, and we aimed to map its prevalence and the presence of comorbidities, as well as to identify possible populations at risk for cardiovascular complications.
  
  
  METHODS
  Cross-sectional study using individual-level data from 514 primary care centers, collected from three different types of EHRs. Data were obtained on adult patients with type 2 diabetes (identified by the International Classification of Primary Care [ICPC-2] code, T90, in the problems list). GISs were used for mapping the prevalence of diabetes and comorbidities (hypertension, dyslipidemia, and obesity) by parish, in the region of Lisbon and Tagus Valley. Descriptive statistics and multivariate logistic regression were used for data analysis.
  
  
  RESULTS
  We identified 205,068 individuals with the diagnosis of type 2 diabetes, corresponding to a prevalence of 5.6% (205,068/3,659,868) in the study population. The mean age of these patients was 67.5 years, and hypertension was present in 71% (144,938/205,068) of all individuals. There was considerable variation in diagnosed comorbidities across parishes. Diabetes patients with concomitant hypertension or dyslipidemia showed higher odds of having been diagnosed with cardiovascular complications, when adjusting for age and gender (hypertension odds ratio [OR] 2.16, confidence interval [CI] 2.10-2.22; dyslipidemia OR 1.57, CI 1.54-1.60).
  
  
  CONCLUSIONS
  Individual-level data from EHRs may play an important role in chronic disease surveillance, namely through the use of GIS. Promoting the quality and comprehensiveness of data, namely through patient involvement in their medical records, is crucial to enhance the feasibility and usefulness of this approach.
authors.affiliation: Centro de Investigação em Saúde Pública, Escola Nacional de Saúde PúblicaPortuguese School of Public HealthUniversidade Nova de LisboaLisboaPortugal; Centre for Health InformaticsAustralian Institute of Health InnovationMacquarie UniversitySydneyAustralia.
authors.forename: Liliana
authors.identifier: 0000-0003-1020-3402
authors.initials: L
authors.lastname: Laranjo
authors.affiliation: NOVA Medical School/ Faculdade de Ciências Médicas Family Medicine Department Universidade Nova de Lisboa Lisboa Portugal.
authors.forename: David
authors.identifier: 0000-0001-6785-1510
authors.initials: D
authors.lastname: Rodrigues
authors.affiliation: Faculty of Human and Social Sciences Universidade Nova de Lisboa Lisboa Portugal.
authors.forename: Ana Marta
authors.identifier: 0000-0003-3665-7592
authors.initials: AM
authors.lastname: Pereira
authors.affiliation: APDP-Diabetes Education and Research Center Universidade Nova de Lisboa Lisboa Portugal.
authors.forename: Rogério T
authors.identifier: 0000-0001-8840-7208
authors.initials: RT
authors.lastname: Ribeiro
authors.affiliation: APDP-Diabetes Education and Research Center Universidade Nova de Lisboa Lisboa Portugal.
authors.forename: José Manuel
authors.identifier: 0000-0002-9977-9995
authors.initials: JM
authors.lastname: Boavida
keywords: diabetes mellitus; electronic health records; geographic information systems; health records; personal; primary health care