Using STD Electronic Medical Record Data to Drive Public Health Program Decisions in New York City

摘要

Electronic medical records can house patient information gathered over time and at multiple sites, thus they have the potential to increase continuity of care and improve service delivery in a multiclinic system. The New York City Department of Health and Mental Hygiene implemented an electronic medical record system in its 10 sexually transmitted disease clinics during 2004 and 2005. We examine the use of real-time electronic medical record data analyses to evaluate clinical services or program activities and present 3 examples of such analyses that have led to program improvements. Analyses of electronic medical record data have produced changes in clinical practice that in turn have resulted in more effective staff use, increased disease detection, and increased clinic capacity. ADVOCATES OF ELECTRONIC medical records have described the advantages they offer with respect to quality of health care, largely because they can reduce medical recording errors, improve efficiency, and promote patient safety. 1 , 2 Despite these advantages, however, health care settings have been slow to adopt electronic medical records, 3 , 4 and estimates of their prevalence vary widely. 5 Although some authors have described the use of electronic health care quality indicators in other clinical settings, there have been few published descriptions of the use of electronic medical record systems in sexually transmitted disease (STD) clinics. 6 – 8 Because persistent and untreated sexually transmitted infections can lead to adverse outcomes such as infertility, ectopic pregnancy, and pelvic inflammatory disease, 9 , 10 timely identification and treatment of STDs is important with respect to interrupting disease transmission and sequelae in a population. An electronic medical record system was implemented in the 10 New York City Department of Health and Mental Hygiene (DOHMH) public STD clinics between August 2004 and September 2005, replacing all paper charts. We examine an important use of electronic medical records in New York, conducting real-time analyses evaluating the city's clinical services and program activities. In the 4 years since implementation of the STD electronic medical record system in New York City, several such analyses have been performed, leading to programmatic decisions that have saved resources while maintaining or improving standards of patient care. We describe 3 examples of these programmatic analyses.