Amirfar et al. BMC Public Health 2011, 11:753 http://www.biomedcentral.com/1471-2458/11/753 C O R R E S P O N D E N C E Open Access Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience Sam Amirfar*, John Taverna, Sheila Anane and Jesse Singer Abstract Background: Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors’ whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way. Method: In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor. Results: From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it. Conclusions: Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health. Background In 2004, in an effort to help New Yorkers live longer and healthier lives, the New York City Department of Health and Mental Hygiene (DOHMH) undertook a policy initiative called Take Care New York (TCNY). The goal of TCNY is to improve population health by helping New Yorkers take discrete and identifiable steps to improve their health through focusing on ten items ranging from prevention to health screening and chronic disease management. After identifying these ten areas (see Table 1), the DOHMH, guided by then Commis- sioner Thomas Frieden, tracked these TCNY measures to monitor the city’s progress [1]. In early 2005, the Commissioner also set up a Taskforce at the DOHMH, the Primary Care Information Project (PCIP), tasked with reducing health care disparities among New * Correspondence: samirfa1@health.nyc.gov Primary Care Information, Project New York City, Department of Health and Mental Hygiene 42-09 28th St., 12th floor, Long Island City, NY 11101, USA Yorkers, especially those living in lower socioeconomic neighborhoods, through health information technology. PCIP was established to help low-income, disadvantaged communities and the providers who deliver health care to these communities take advantage of technological innovations in order to improve the quality of care of their patients as measured by the ten TCNY measures [2]. Recognizing the opportunity to improve care and collect data on the TCNY defined clinical areas, PCIP, in collaboration with our selected EHR vendor, devel- oped the corresponding TCNY quality measures for use at the point of care. These measures at the point of care became the basis of our clinical decision support sys- tems (CDSS). Within the EHR, these CDSS alerts inform the provider by a series of prompts on their computer screen that the patient they are currently seeing in their office is due for specific health maintenance screenings or chronic disease management based on the patient’s age, gender, and comorbidities. © 2011 Amirfar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.