Amirfar et al. BMC Public Health 2011, 11:753 http://www.biomedcentral.com/1471-2458/11/753 Page 2 of 8 Table 1 Summary Table of Take Care New York Indicators TCNY Agenda Item 1. Have a Regular Doctor or Other Health Care Provider 2. Be Tobacco Free 3. Have a Healthy Heart 4. Know Your HIV Status 5. Get Help for Depression 6. Live Free of Alcohol or Drugs 7. Get Checked for Cancer 8. Get the Immunizations You Need 9. Make Your Home Safe & Healthy 10. Have a Healthy Baby Indicator Adult New Yorkers without a regular doctor Adult New Yorkers who smoke Proportion of New Yorkers with high blood pressure and cholesterol. Proportion of New Yorkers with well-controlled hypertension, cholesterol & diabetes Number of New Yorkers who die from HIV/AIDS Prevalence of untreated depression Alcohol-attributable mortality Drug-related deaths Screening rates for breast cancer Screening rates for cervical cancer Screening rates for colon cancer Influenza immunizations among New Yorkers age 65+ Women who die from intimate partner homicide Children with newly-identified blood lead levels (BLL) > 15 μg/dl and an identified lead-based paint hazard Infant mortality rate per 1, 000 live births This collaborative development between a govern- ment entity and a private EHR vendor resulted in a unique public health oriented electronic health record, which has actionable quality measures that prompt providers to take steps for preventive care or chronic disease management for various health issues targeted within New York City. A public health oriented EHR is an electronic health record system which in addition to enabling the provider to provide appropriate healthcare resources to the care of their patients, allows for safe, convenient, and timely transfer of public health infor- mation bilaterally between providers and their local and state public health organizations and departments. To contribute to the measurement of the TCNY mea- sures, the aggregate values of the corresponding mea- sures are transmitted monthly to DOHMH. Analysis of such data allows for improved efficacy of important public health programs such as infectious disease sur- veillance, chronic disease prevalence studies, and envir- onmental exposures, to name a few. This method of gathering data from community providers has the potential of eventually replacing the traditional slow and incomplete methods of data collection, such as chart reviews, which public health agencies have been using for more than 100 years. Since we developed this public health oriented EHR, we have implemented the system to approximately 2600 providers in the five boroughs of New York City representing approximately 2.5 million patients. In 2010 alone, our CDSS alerts have been involved in million patient encounters. While the EHR development process has been long, the details of the journey may help illuminate the pathway for other local or state governments with a similar interest. Methods PCIP considers electronic health records to be one of the best and most scalable methods of helping commu- nity providers improve the care they provide while con- taining providers’ operational costs in the long term after an initial upfront investment [3,4]. EHRs allow documentation of a clinical encounter in a structured codified format with electronic ordering and recording of laboratory tests, radiologic examinations, immuniza- tions, vital signs, medication and allergies to name but a few important functionalities necessary for a clinical encounter. Structured data is the crux of public health functionality because it enables: quality measures to assess ambulatory care quality, CDSS to communicate best clinical practices to providers, and public health interfaces to link with existing DOHMH systems. All three of these functionalities are at the core of an ideal public health-oriented EHR, and all three are enabled by structured data. At the time of PCIP’s establishment, there was no EHR that included the public health func- tionality that we envisioned. Before implementing EHR systems in the community, the DOHMH tried to take advantage of existing techno- logical innovations to improve the disparity of health care through the distribution of personal digital assis- tants (PDA) to physicians working in federally-funded community health centers [5]. The PDAs were primarily used for electronic prescribing, while health alerts and information on emergency preparedness were available for download via a website accessible from the devices and maintained by an outside vendor. These health alerts were an early, primitive form of CDSS. They informed providers of potentially relevant information in hopes of helping them make an informed clinical