Electronic health records may hold key to better health planning within a county

  • Oct. 23, 2013

Indiana University-Purdue University Indianapolis researchers have received a $200,000 grant to study the feasibility of using electronic health records to measure health outcomes of Marion County residents by neighborhood or even by census block for public health planning.

The two-year study will also determine the validity of integrating those records with community health indicators such as parks, health care facilities and grocery stores selling fresh produce, said the study’s principal investigator Brian Dixon, an assistant professor of health informatics in the IU School of Informatics and Computing at IUPUI. Dixon is also a research scientist at the Regenstrief Institute and the Roudebush VA Medical Center. The research team also includes several other IUPUI researchers from the IU School of Medicine and the Polis Center as well as epidemiologists from the Marion County Public Health Department.

The project is one of 11 that received research awards, totaling $2.7 million, facilitated by the National Network of Public Health Institutes, with guidance from the National Coordinating Center for Public Health Services and Systems Research housed at the University of Kentucky’s College of Public Health. Support for this research was provided by a grant from the Robert Wood Johnson Foundation.

Current information on the health of people living in Marion County available to public health officials is based on samples representing county-wide data, Dixon said. But the increasing availability and use of electronic health records may permit public health officials to peer within the county at smaller and smaller groups of residents, he said. If that’s possible, public health officials could more readily determine which areas of the county are most in need of certain public health programs.

“When there is a limited budget for, say, preventing diabetes, the county health department has to determine how to spend its resources,” Dixon said. “One choice is to evenly divide the money across all communities within the county, some of which probably don’t have as much need as others. A second choice is to identify specific areas within the county that might need intervention the most.”

The growing use of electronic health records offers the potential to follow the second choice, Dixon said. Researchers will look at aggregate data for finite geographical regions within the county to measure the health of a particular neighborhood or set of neighborhoods and then use that information to identify where certain public health programs or interventions are most needed, he said.

Researchers will analyze the electronic records of smaller and smaller groups of county residents, including by ZIP code (average population of 8,000), neighborhoods (average population of 3,000 to 4,500) and census block (average population of 1,500), the smallest population grouping to be examined.

“We’re not sure how small you can go until you have no confidence in what the data are telling you,” Dixon said.

The first test is to come up health measurements at a sub-county level for things like how many people in a particular area receive flu shots, Dixon said. Then Dixon and other researchers will be able to take that data and link it to socio-economic factors, enabling them to tease out what determinants make one area healthier than another.  

In the current era of health reform, public health transformation and diminishing resources, practitioners and policy-makers need sound evidence on the most efficient and impactful approaches for improving population health, according to the National Network of Public Health Institutes. Research findings resulting from the electronic health records study and the other projects will provide relevant information to public health practitioners and policy-makers, contributing evidence that is urgently needed to improve quality, efficiency and equity in public health practice with an ultimate goal of improving population health nationwide.

About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change.

About the National Coordinating Center for Public Health Services and Systems


The goal of the National Coordinating Center is to grow the field of public health services and systems research by coordinating current public health services investments, supporting real-world applications, and strengthening the capacity of researchers and practitioners. The center also works to determine the future direction of the field’s research initiatives; translate that research into practice; increase the visibility of the work; and attract other funders to the field


About the National Network of Public Health Institutes

Created in 2001 as a forum for public health institutes, the National Network of Public Health Institutes convenes its members and partners at the local, state and national levels in efforts to address critical health issues.