Electronic Health Record (EHR)-Based Community Health Measures: An Exploratory Assessment of Perceived Usefulness by Local Health Departments

Background Given the widespread adoption of electronic health record (EHR) systems in health care organizations, public health agencies are interested in accessing EHR data to improve health assessment and surveillance. Yet there exist few examples in the U.S. of governmental health agencies using EHR data routinely to examine disease prevalence and other measures of community health. The objective of this study was to explore local health department (LHD) professionals’ perceptions of the usefulness of EHR-based community health measures, and to examine these perceptions in the context of LHDs’ current access and use of sub-county data, data aggregated at geographic levels smaller than county. Methods To explore perceived usefulness, we conducted an online survey of LHD professionals in Indiana. One hundred and thirty-three (133) individuals from thirty-one (31) LHDs participated. The survey asked about usefulness of specific community health measures as well as current access to and uses of sub-county population health data. Descriptive statistics were calculated to examine respondents’ perceptions, access, and use. A one-way ANOVA (with pairwise comparisons) test was used to compare average scores by LHD size. Results Respondents overall indicated moderate agreement on which community health measures might be useful. Perceived usefulness of specific EHR-based community health measures varied by size of respondent’s LHD [F(3, 88) = 3.56, p = 0.017]. Over 70% of survey respondents reported using community health data, but of those < 30% indicated they had access to sub-county level data. Conclusion Respondents generally preferred familiar community health measures versus novel, EHR-based measures that are not in widespread use within health departments. Access to sub-county data is limited but strongly desired. Future research and development is needed as LHD staff gain access to EHR data and apply these data to support the core function of health assessment. Electronic supplementary material The online version of this article (10.1186/s12889-018-5550-2) contains supplementary material, which is available to authorized users.

The study is conducted by researchers at Indiana University and funded by Robert Wood Johnson Foundation.

STUDY PURPOSE
The purpose of this study is to identify community health measures that could inform whether newer sources of data will enable improved assessment of population health.

NUMBER OF PEOPLE TAKING PART IN THE STUDY:
If you agree to participate, you will be one of approximately 500 subjects who will be participating in this research.

PROCEDURES FOR THE STUDY
If you agree to be in the study, you will be asked to complete a survey, either online or paper copy survey. The survey will require approximately 5-10 minutes of your time. The survey will ask questions that gather information about the size of your organization, the extent to which community health data is used in your job, type of data worked with on a daily basis, and your prioritization of community health measures.

RISKS OF TAKING PART IN THE STUDY:
While on the study, the risks are: Minimal risk is associated with participating in this research. Some people feel that providing information on a survey is an invasion of privacy and are uncomfortable answering some questions.

BENEFITS OF TAKING PART IN THE STUDY:
The benefits to participation that are reasonable to expect are: By providing your input about the community health measures you have the potential to contribute to our understanding of the social and environmental determinants of health.

ALTERNATIVES TO TAKING PART IN THE STUDY:
Instead of being in the study, you have these options: The only alternative is not participating.

CONFIDENTIALITY
Efforts will be made to keep your personal information confidential. Electronic survey responses and any printed versions of survey results will be securely stored and accessible only to the principal investigator and staff directly involved in this project. Survey results will be destroyed following completion of the project (expected date: 12/31/2015). Anonymity will be maintained as names will not be collected in the course of this research and there will be no direct identification of subjects. Any identifying information, such as names of organizations, etc, will be removed from the survey results prior to analysis.
We cannot guarantee absolute confidentiality. Your personal information may be disclosed if required by law. Your identity will be held in confidence in reports in which the study may be published. Organizations that may inspect and/or copy your research records for quality assurance and data analysis include groups such as the study investigator and his/her research associates, the Indiana University Institutional Review Board or its designees, the study sponsor, the Indiana CTSI, and (as allowed by law) state or federal agencies, specifically the Office for Human Research Protections (OHRP), the National Institutes of Health (NIH), etc., who may need to access research records.
PAYMENT You will not receive payment for taking part in this study. 11. How do you typically define neighborhood for purposes of data analysis? Check all that apply.

CONTACTS FOR QUESTIONS OR PROBLEMS
By the street boundaries specified by local government or neighborhood groups.
As a collection of geographic units (e.g. block groups, census tracts, or ZIP codes) that most closely matches specified street boundaries Based on distance from a neighborhood landmark.
Based on cumulative population surrounding a neighborhood landmark.