ESP/MDPHNET (PI: Michael Klompas, MD, MPH)
ESP (Electronic medical record Support for Public health) is an open-source EHR-based software platform that enables automated notifiable disease reporting and surveillance for acute and chronic conditions that is more timely, complete, granular, and efficient than traditional surveillance. It functions by tabulating electronic health record data, organizing the data into common tables and mapping key variables to common terms, analyzing the data for conditions of public health interest, and then transmitting case reports or aggregate summaries to health departments. ESP was originally developed as a partnership between the Department of Population Medicine, the Massachusetts Department of Public Health (MDPH), and local clinical practice groups. It has since been adopted and adapted for public health surveillance in multiple additional states, and is the technology platform underlying the Multistate EHR-based National Disease Surveillance (MENDS) system.
In Massachusetts, there are currently 12 ESP installations that collectively cover more than 60% of the state’s population for reportable infectious disease cases. A subset of practices that cover about 20% of the state population also contribute to chronic disease surveillance via a distributed network called MDPHnet.
ESP and MDPHnet include a web-based data visualization tool called the “RiskScape.” RiskScape allows users to easily and intuitively generate maps showing disease prevalence rates by zip code, bar graphs describing the epidemiologic characteristics of cases, and time-series analyses showing changes in disease rates over time. These data are used by MDPH to monitor the health of the Commonwealth, identify disparities in health status, track patterns of care, and assess outcomes with a view to informing public health responses.
In response to the COVID-19 pandemic, new algorithms were created and implemented to support timely surveillance for both COVID-like illness and other respiratory viruses. These tools have helped MDPH and partners better understand changes in COVID-19 activity, the differential impact of the pandemic on different segments of society, and interactions between COVID-19 and HIV and other chronic diseases. A recent publication in Public Health Reports highlights part of this work, Syndromic Surveillance for COVID-19, Massachusetts, February 2020–November 2022: The Impact of Fever and Severity on Algorithm Performance; and the Boston Globe gave a shoutout to the team’s efforts in COVID-19 public health emergency ends but experts urge caution.
ESP also has a vaccine-safety module that is being optimized to monitor the safety of COVID and Mpox vaccines. The project “Electronic Support for Public Health-VAERS for COVID-19” is the most recent iteration of a long-standing CDC-funded initiative, which leverages ESP for vaccine safety surveillance and reporting to the CDC/FDA’s Vaccine Adverse Event Reporting System (VAERS). More information about ESP-VAERS can be found here.
The ESP team is in the process of expanding and adding new sites across Massachusetts, both for infectious disease and other chronic condition surveillance. The team also continues to create and refine EHR-based strategies to better capture and utilize data to support public health in-state and beyond. Additional information, including relevant documentation of the system and publications can be found at esphealth.org.
Funder: Massachusetts Department of Public Health