De-identified electronic health records data is being used in a small Minnesota town to monitor the heart health of its population and to reduce risk factors for cardiovascular disease.
In 2009, Minneapolis Heart Institute Foundation, along with Allina Health, New Ulm Medical Center and the community of New Ulm, began a 10-year population health research project to learn if heart attacks and heart disease risk factors could be decreased through collaborative efforts.
Called the Heart of New Ulm Project, it focuses on reducing factors known for increasing heart attack risk, including high cholesterol, high blood pressure, uncontrolled glucose, obesity, tobacco use, physical inactivity, low fruit and vegetable intake, as well as medication underutilization and non-adherence.
Recently published data for the first five years of the project, based on key cardiovascular health indicators, suggest that the initial findings are very positive, according to Abbey Sidebottom, managing scientist at Allina Health and lead investigator.
“We focused on about 6,000 residents aged 40 to 79, which is the age group most likely to experience a preventable heart attack,” says Sidebottom, an epidemiologist, who argues that the study shows that the overall health of the population improved substantially from 2009 to 2013.
The percentage of patients who had normal blood pressure increased from 79 percent to 86 percent, while the percentage of those with total cholesterol under 200 rose from 59 percent to 64 percent. In addition, researchers found positive changes in fasting glucose and triglycerides.
According to Sidebottom, the New Ulm findings were compared with data from the National Health and Nutrition Examination national survey, using similar age and racial groups for comparison over that the same five-year period. Researchers discovered that these conditions either stayed the same or worsened across the country.
“When we looked at that national data, it told us that the improvements that we saw in New Ulm appear to be due to the community-wide intervention,” she says. Those efforts included free health screenings, not only in healthcare settings but in workplaces, restaurants and at community spaces and events, including farmers markets and concession stands, as well as programs to promote healthier behaviors.
New Ulm, with a population of more 13,000 residents, has just one healthcare provider in the community—New Ulm Medical Center, which is owned by Allina Health—a fact that Sidebottom believes was critical to enabling researchers to use the EHR to effectively monitor patients. When the project was launched, an estimated 90 percent of the community’s adult residents had a medical record in the system.
“We use the same Epic electronic health record for both our patient and clinic systems, so it’s one record per person, no matter where you’re being seen,” says Sidebottom. “If you were starting out at New Ulm Medical Center but then needed to be referred to a specialty within our system, we would still have that information. In this kind of a rural setting, the EHR is a great tool for monitoring health trends at a population level.”
She adds that the EHR system was used for “programmatic purposes” by “running an algorithm on data to identify people who maybe didn’t yet have diabetes or heart disease but we could tell were at high risk.” The one category of data Sidebottom wishes was more frequently populated in the EHRs from a cardiovascular disease prevention perspective is lifestyle information, such as fruit and vegetable consumption and exercise that was subsequently collected in separate health screenings.
“I know that a lot of providers ask their patients these kinds of lifestyle questions, but our electronic health record did not contain any systematic, standard measures,” she says.
Going forward, the project plans to compare New Ulm to another regional community also served by Allina Health and conduct a similar analysis based on EHR data.
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