Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience

In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor.From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it.Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health.In 2004, in an effort to help New Yorkers live longer and healthier lives, the New York City Department of Health and Mental Hygiene (DOHMH) undertook a policy initiative called Take Care New York (TCNY). The goal of TCNY is to improve population health by helping New Yorkers take discrete and identifiable steps to improve their health through focusing on ten items ranging from prevention to health screening and chronic disease management. After identifying these ten areas (see Table 1), the DOHMH, guided by then Commissioner Thomas Frieden, tracked these TCNY measures to monitor the city's progress [1]. In early 2005, the Commissioner also set up a Taskforce at the DOHMH, the Primary Care Information Project (PCIP), tasked with reducing health care disparities among New Yorkers, especially those living in lower socioeconomic neighborhoods, through health information technology. PCIP was established to help low-income, disadvantaged communities and the providers who deliver health care to these communities take advantage of technological innovations in order to improve the quality of care of their patients as measured by the ten