Benefits and Rationale
Before embarking on an effort to gain access to EHI (electronic health information) through healthcare organizations (HCOs) and healthcare providers (HCPs), it’s important for public health authorities (PHAs) to understand what benefits this access can deliver, and what the rationale is for undertaking this effort.
Benefits of Direct Access
Direct access to EHI can benefit PHAs, HCOs, and clients/patients by removing barriers to timely and secure access to patient and clinical information and supports reporting to PHAs.
Public Health Benefits
- More complete patient and clinical information is rapidly available to public health to support routine and emergency case follow-up, including other patients that may have been exposed to infectious diseases. One PHA identified additional potential hepatitis B cases during an outbreak by directly accessing case medical histories through electronic health records (EHRs). Another PHA used EHR data to identify newborns requiring post-delivery syphilis testing by reviewing the pregnancy status of individuals diagnosed with syphilis during routine case investigation activities.
- Efficiency in obtaining patient and clinical information for routine surveillance activities, during outbreaks, and other public health events. In one example, a PHA needed to set up a measles post-exposure prophylaxis clinic because they were unable to access EHI over the weekend when medical offices were closed. Access to EHI, which would have allowed the PHA to quickly verify the immunization status of exposed individuals. In another example, PHA emerging infections programs conduct detailed medical record reviews as part of routine surveillance activities using standardized case report forms. Access to EHI is more efficient for these disease investigations because PHA staff do not need to go onsite to access the records and they can do so from their office.
- Efficiency in case management work, such as identification of patients receiving care elsewhere. For example, a PHA could use EHI to determine where individuals with tuberculosis, monitored through case management activities, are receiving care. Access to EHI enables PHAs to more efficiently retrieve relevant data from patients’ EHRs, facilitating streamlined collaboration with primary care providers and consulting physicians.
- Bidirectional communication and data sharing between PHAs and HCOs. Sharing data between PHAs and HCOs is vital for effective public health responses, especially during outbreaks of healthcare-associated infections (HAIs) and antimicrobial resistance (AR). However, challenges such as technological limitations, administrative hurdles, inconsistent data collection, and concerns over patient confidentiality hinder seamless data exchange. Manual reporting adds strain to already overburdened staff, making proactive planning and standardized systems essential. The Council for Outbreak Response: Healthcare-Associated Infections (HAIs) and Antimicrobial-Resistant (AR) (CORHA) Policy Workgroup is working to improve transparency and consistency in data sharing by advocating for clearer policies, national mandates, and resources that support both public awareness and patient privacy. For additional information and resources see a recent spotlight about HAIs written by the Workgroup chairs.
- Ability to review information in the EHR and compare with electronic laboratory record (ELR) results which, when discordant, might indicate potential errors in the data or reporting and could warrant further investigation. For example, the health department receives an ELR report indicating the patient has tested positive for Salmonella sp., but the discharge summary lists the diagnosis as viral gastroenteritis. The discordance between the ELR and the EHR raises a flag and could mean that the provider overlooked the laboratory result, or has not updated the preliminary diagnosis in the EHR. A third, but less likely cause is that the laboratory made an error in data entry or sent the result under a different patient’s name.
Healthcare Organization Benefits
- Avoiding multiple, sometimes paper-based, information requests on reportable conditions from PHAs to the health information management (HIM) system and infection prevention teams, or others.
- Building a relationship with the PHA, which allows for information about outbreaks or other public health events to be shared, and supports better participation in community health needs assessments.
- HCOs can benefit from receiving EHI back from PHAs, such as immunization history and infectious disease forecasts, or newborn screening results from public health laboratories.
Client and Patient Benefits
- Enabling public health professionals’ access to EHI before interviewing clients and patients helps avoid asking the patient to repeat information, reducing frustration, and improving the patient experience.
- Allows for the identification of discrepancies between a client’s and patient’s understanding of information and what is in their medical record.
- Helps protect clients and patients by enabling faster and more effective detection and response to potential public health threats, reducing the risk of illness and improving health outcomes.
Barriers Addressed by Access
Barriers are often present when conducting response activities for public health events and when investigating anomalies found through the analysis of routine surveillance data. Typical barriers that EHI access can address include:
- Laborious and time-consuming manual data entry and review of client and patient data and information, sometimes including information that has been received in faxes.
- Administrative burdens of information sharing from HCOs and PHAs.
- Incomplete patient information and repeated contact with HCOs to request information as investigations unfold.
- Delays in taking public health action while waiting for access to patient information.
When PHAs are able to have direct access to EHI from HCOs in their communities, they work more efficiently and with better, more complete and accurate patient clinical information enabling more timely public health actions that ultimately prevent further disease, death, and disability.
Success Story : Marisa Hopper, Tennessee Department of Health
The Tennessee Department of Health’s journey to operationalizing electronic health information access demonstrates how persistence, partnership, and strategy can transform disease surveillance statewide. Under the leadership of Marisa Hopper, the department expanded EHR access from a handful of hospitals to nearly 90% of major health systems, significantly reducing the need for manual record requests and faxes. Hopper’s team built trust by emphasizing the burden relief for healthcare providers and backing the access requests with legislative references and letters from state leadership. Once access was secured, investigations became faster and more efficient, enabling staff to quickly answer critical questions, such as pregnancy status for hepatitis B cases, directly from the record. “It just makes everybody’s life so much easier,” Hopper explained, noting that EHR access has strengthened relationships with infection prevention teams, improved timeliness, and enhanced completeness of case investigations across all infectious disease programs.
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References
Creswell, Paul D. PhD; Mader, Sara RN, MPH; Modji, Komi K.S. MD, MS, CPH; McCoy, Katherine E. PhD. A Breath of Fresh Air: Pilot Testing Electronic Case Reporting for Public Health Surveillance of Occupational Lung Diseases in Wisconsin. Journal of Public Health Management & Practice 31(4):p 558-565, July/August 2025. DOI: 10.1097/PHH.0000000000002147 https://journals.lww.com/jphmp/abstract/2025/07000/a_breath_of_fresh_air__pilot_testing_electronic.8.aspx Accessed June 24, 2025.