Improvements to EHRs using the 2015 Priority List items can promote improved communication between ambulatory practices and public health agencies. There are three primary public health informatics functions that can leverage an EHR. First, patient data from the EHR in combination with survey data can generate a picture of population health status that highlights the need for intervention or screening. Second, public health policies and programs can be improved through the use of EHR data to monitor compliance with policies, and to track performance against guidelines for well-child care, immunizations, and disease management. Third, immunization data and other data important for public health can be captured and shared.
For example, obesity metrics are a public health priority. Req-2002 calls for capture of appropriate obesity measures, Req-2044 calls for age-specific norms, and Req-2045 calls for reporting and alerting out of range data.
Req-2016 calls for recording parent notification of newborn screening results that will encourage EHR users to be sure that results were checked and completed. 2017 calls for recording newborn screening diagnosis and all outstanding newborn screening tasks on the problem list so that all providers will see them. Req-2018 calls for making decision support, such as the American College of Medical Genetics and Genomics (ACMG) ACT sheets, available to assist providers in management of rare conditions that might be seen only once in a lifetime of practice.
Req-2034, to alert for a child in foster care who is not also in Medicaid, is intended to help support an important public health intervention to improve child welfare.
The 2015 Priority List strengthens the capture and communication of child information in the EHR that is also used to support important public health initiatives.
The 2015 Priority List does not include every important requirement, such as immunization forecasting and immunization clinical decision support, which also serve public health objectives. These and other requirements deserve more attention in the future. At the time of this writing (August 2015) they were not included because the requirements are complex, subject to changing ACIP guidelines, and still require full validation using a large number of test cases available from CDC and AAP. Immunization forecasting is an appropriate role for public health and can be integrated into immunization information systems (IIS) or registries with the decision support recommendations displayed by the EHR.