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Curr Infect Dis Rep. 2019 Aug 26;21(10):32. doi: 10.1007/s11908-019-0694-5.

Electronic Health Record Use in Public Health Infectious Disease Surveillance, USA, 2018-2019.

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Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA.
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA.
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.



Electronic health records (EHRs) are an excellent source of data for disease symptoms, laboratory results, and medical treatments. Thus, EHR data may improve the completeness of notifiable disease case reporting and enable longitudinal collection of disease data. The purpose of this review is to examine the current state of EHR use in public health infectious disease surveillance in the USA.


A wide variety of EHR data is used in infectious disease surveillance. EHR data were used to assess the incidence of Lyme disease and identify newly diagnosed HIV infections. EHR disease detection algorithms combined laboratory reports, diagnosis codes, and medication orders to identify cases and, in the case of Lyme disease, found incidence rates 4-7 times higher than those from traditional surveillance. EHR data were also used to evaluate temporal trends in sexually transmitted disease testing, positivity, and re-testing in several primary care settings. Multiple studies were also able to control for additional confounders in multivariable models, such as number of sexual partners and concurrent infections, because of the breadth of data available in EHR systems. Studies highlighted in this review demonstrate that EHR data enhance provider-based and laboratory-based disease reports and may facilitate more complete case reporting. EHR data also provides corollary patient information that enables longitudinal disease reporting and analysis of important health outcomes. As public health infrastructure and investment allow health departments to establish closer relationships with healthcare providers, EHR data use in public health surveillance activities should continue to increase.


Automated public health surveillance; Electronic health records; Infectious diseases; Public health surveillance


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