Public health officials are finding that, in many cities, there are significant health disparities and health gaps among neighborhoods, with childhood obesity rates and tobacco use much higher in some neighborhoods compared to others, which can contribute to different life expectancy rates. In the Denver metropolitan area, a collaborative pilot project is leveraging electronic health record (EHR) data to monitor public health trends and evaluate interventions, and the data service is providing public health officials with data to identify and address health disparities.
The Colorado Health Observation Regional Data Service (CHORDS), based in Denver, is a regional partnership between Colorado health providers, public health departments and the University of Colorado Denver to share health data in order to track population health trends and develop effective interventions. CHORDS, which is a pilot project by Denver Public Health, a part of Denver Health and Hospital Authority, collects, analyzes and presents data from participating partner EHRs into one registry per topic that can be used to monitor population health and conduct research.
Currently, there are 12 partner organizations that contribute data to CHORDS, including Children’s Hospital Colorado, Kaiser Permanente of Colorado, Denver Health and the Colorado Alliance for Health Equity and Practice, and a number of federally qualified health center (FQHC) organizations. Technology partners for the project include the Denver Public Health Department and the Colorado Clinical Translational Sciences Institute.
Each registry collects and presents health information specific to its topic area. For example, to monitor tobacco use, CHORDS collects demographic characteristics and geographic information on the patient and their visit, in addition to whether or not the patient uses or is exposed to tobacco. This information is extracted and used to populate the tobacco registry.
Public health officials in the Denver area are tapping into data from CHORDS to see the prevalence of health issues, such as childhood obesity or tobacco use, in the region, and can even map the variance down to specific neighborhoods. Officials can then take the data to city council representatives and community forums to open up discussions about health inequalities and disparities, according to Art Davidson, M.D., director of informatics and epidemiology at Denver Public Health and CHORDS project director.
“Our goal,” Davidson says, “is to get politicians, policymakers, community-based organizations and community advocates interested in moving the agenda and moving the needle on public health issues.”
CHORDS, which refers to both the technology platform and a virtual organization of partners, currently has registries on obesity, tobacco use and exposure, diabetes, cardiovascular disease and depression. Examples of relevant data fields pulled from EHR data include, within the obesity registry, BMI, height and weight, and within diabetes, diabetes diagnosis codes and hemoglobin A1C lab test results. The 12 health entities in Colorado that are participating contribute data broken down by race, gender, age and location. Project leaders want to expand the data service to include registries on asthma, hepatitis C and congenital heart disease.
The use of EHR data for health monitoring is not unique, but applying these efforts at a local level is a relatively new concept, Davidson says. There are several national initiatives that have developed networks, including the Food and Drug Administration (FDA)-funded Sentinel Initiative and PCORI-funded PCORnet. Efforts to adapt these national models have been implemented locally through New York City’s Primary Care Information Project, and the MDPHnet program in Massachusetts.
According to Davidson, data sharing in the CHORDS health data network is powered by PopMedNet, a software application that enables the use of distributed data networks. The CHORDS instance of PopMedNet is hosted and supported by the University of Colorado Cancer Center’s Research Informatics Shared Resource with blended funding from National Institutes of Health (Colorado Clinical and Translational Sciences Institute) and a variety of grants from Colorado governmental and foundation funders.
Work to build CHORDS began about five years ago and project leaders first had to seek out healthcare provider partners to share their healthcare data and to make it available for public health agencies and researchers. The project leaders started with FQHC facilities and also reached out to other non-profit healthcare organizations. “It was somewhat challenging because we’re asking them to share health data for public use, so we had to make the case and build why this is important,” Davidson says. Each participating health care provider chooses which registry they want to participate in and contribute data to. As an example, a children's hospital would not provide data on adult indicators.