Assessment of electronic health records for infectious disease surveillance, prevention and control

Electronic health records (EHR) data could greatly help infectious disease surveillance, but their use varies across Europe. Researchers mapped EHR use to assess the feasibility of using EHR data for infectious disease surveillance.

What is the issue?

Electronic health records (EHR) could offer great opportunities for infectious disease surveillance, from improving its timeliness and completeness, to lessening the burden for reporting data. The data collected could provide relevant information in a number of areas, including laboratory results, clinical diagnoses and disease prevention and treatment.

However, the use of EHR across European Union (EU) and European Economic Area (EEA) countries varies and is not currently well described. Mapping the use of EHR could help to assess the feasibility of using EHR data for infectious disease surveillance in the EU/EEA.

How did we help?

RAND Europe was commissioned by the European Centre for Disease Prevention and Control (ECDC) to map the current use of EHR across EU/EEA countries and their feasibility for surveillance of infectious diseases and related special health issues.

The study included:

1. Scoping interviews to inform the development of the mapping survey questions.
2. A survey of key stakeholders across EU/EEA countries.
3. A targeted search of literature, as well as interviews to fill remaining gaps in data across EU/EEA countries or disease areas.
4. A mapping exercise collating the gathered data.

What did we find?

• Unified national EHR systems across primary and secondary care are uncommon among EU/EEA countries, with only six of the 17 countries reporting unified systems across primary and secondary care.
• There is wide variability in the degree of transition from paper-based to fully electronic systems within EU/EEA countries, with only four countries (Estonia, Finland, the Netherlands, and Norway) reporting a high degree of implementation of electronic systems.
• The presence of a unified EHR system and the level of transition to a completely computerised medical record system are not directly related to using the EHR system either to share data with public health authorities or to engage in infectious disease reporting.
• Only around one third (35%) of the included countries have processes in place to support interoperability – the sharing of different types of information – between national or subnational systems and public health authorities (PHAs).
• Almost half of the countries (Austria, Croatia, Estonia, Finland, Malta, Portugal, Romania, and the United Kingdom) appear to share some data with external public health organisations such as ECDC, even though many respondents were unsure about secondary use of EHR data by PHAs for disease surveillance, or what mechanisms were in place to permit data sharing.
• As countries move toward fully electronic systems, issues with system usability and lack of staff time and finances seem to be the most significant barrier to EHR implementation.
• Barriers to the use of EHR data encompass concerns over confidentiality and privacy, as well as data quality issues such as the completeness and timeliness of data, and lack of data sharing between organisations.