MDPHnet: Secure,Distributed Sharing of Electronic Health Record Data for Public Health Surveillance,Evaluation, and Planning

Electronic health record systems contain clinically detailed data from large populations of patients that could significantly enrich public health surveillance. Clinical practices’ security, privacy, and proprietary concerns, however, have limited their willingness to share these data with public health agencies.We describe a novel distributed network for public health surveillance called MDPHnet. The system allows the Massachusetts Department of Public Health (MDPH) to initiate custom queries against participating practices’ electronic health records while the data remain behind each practice’s firewall.Practices can review proposed queries before execution and approve query results before releasing them to the health department. MDPH is using the system for routine surveillance for priority conditions and to evaluate the impact of public health interventions.Electronic health record (EHR) systems present substantial opportunities to improve public health surveillance and evaluation. EHRs are rich in detailed clinical data that could significantly enhance public health agencies’ capacity to monitor the spread of communicable diseases, measure burden and care patterns for chronic diseases, and evaluate the impact of public health interventions.1 EHR data tend to be more accurate than self-reports, more granular than hospital discharges or claims data, more detailed than death certificates, more inclusive than survey samples, more complete than clinician-initiated reports, and more timely than all current surveillance sources with the possible exception of telephone notifications.2–5 Notwithstanding EHRs’ potential to revolutionize public health surveillance and evaluation, very few public health agencies have been able to take advantage of EHR data to date.6–8 Barriers include clinical practices’ reluctance to “give” their data to government agencies, heterogeneity between EHR systems, EHRs’ limited capacity for interoperability, and health departments’ lack of capacity to receive and analyze these types of data.6–10 Clinical practices are often concerned about the possibility of security breaches, privacy violations, the exposure of commercial data that might benefit competitors, and use of their data for involuntary comparisons to other practices and practitioners.11,12We describe in this article a new public health surveillance and evaluation tool called MDPHnet that provides the Massachusetts Department of Public Health (MDPH) with secure, controlled access to EHR data from multiple independent clinical practices via a distributed network. Distributed networks effectively manage the tensions between privacy, security, and public health by allowing institutions to retain complete control of their health data, while simultaneously enabling authorized users to submit queries for authorized purposes.12–15 We provide an overview of the design, architecture, governance, and implementation of MDPHnet. We describe 2 proof-of-concept queries that demonstrate MDPHnet’s capacity to enhance routine public health surveillance and evaluation. We also discuss additional potential applications for the system and future options to improve MDPHnet by adding new features, data sources, and links to other distributed networks.