Rates of chronic conditions across populations are key data points in improving people health. While electronic health records (EHRs) are able to offer real-time standardization of health information, chronic disease surveillance is low. A study, published by eGEMs, reports how the New York City (NYC) Macroscope could improve the status quo.

The NYC Macroscope, an EHR-based chronic disease surveillance system, was designed to be comparable to the 2013-14 NYC Health and Nutrition Examination Survey and the telephonic 2013 Community Health Survey. Macroscope is able to examine prevalence of influenza, obesity, depression, smoking rates, vaccinations, treatments, diabetes, hypertension and hyperlipidemia, sorting such data by age, sex and poverty within patient populations.

The report included 392 practices and 716,076 adult patients, covering 10 percent of primary care providers and 15 percent of all adult patients from 2013. Depending on a patient’s domain, data collection was completed from 98 percent for blood pressure in patients with hypertension to 33 percent for depression screening.

“Design and validation efforts undertaken by NYC are described here to provide one potential blueprint for leveraging EHRs for population health monitoring,” concluded Remle Newton-Dame, of the NYC Department of Health and Mental Hygiene, and colleagues. “To replicate a model like NYC Macroscope, jurisdictions should establish buy-in, build informatics capacity, use standard and simple case definitions, establish documentation quality thresholds, restrict to primary care providers and weight the sample to a target population.”