How EHR Data Helped Tackle COVID-19 Health Disparities

The Marion County Public Health Department (MCPHD) in Indiana used EHR data to address health disparities in COVID-19 infection, according to a study published in the American Journal of Public Health (AJPH).

Researchers matched positive case reports from private and public laboratories to EHR data and integrated them into a community-based dashboard to identify neighborhoods facing COVID-19 health disparities.

With this information, public health officials set up testing sites in those neighborhoods in an effort to help mitigate the spread of the virus.

Data analysis shows that the rate of new COVID-19 cases declined in the targeted groups after the county established the testing sites and associated educational campaigns.

“Given the novel and dynamic nature of the pandemic, we based resource allocation decisions on assessments of multiple COVID-19 disease statistics and trends rather than predefined criteria,” Virginia Caine, MD, Marion County Public Health Department director, said in a press release. “This allowed us to reach those most affected.”

“We worked with community partners to identify and address challenges related to COVID testing to increase access,” Caine continued.

The initial community testing site opened on April 2, 2020, in Indianapolis, Indiana, with the first day dedicated to essential personnel. As COVID-19 tests became more readily available, public health officials opened additional community testing sites based on trends in COVID-19 incidence by location, race, and ethnicity to target areas with the highest COVID-19 morbidity.

“Populations at highest risk of disease should receive extra resources from local health departments,” emphasized Brian Dixon, PhD, MPA, Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health director of public health informatics.

“Using surveillance data helps identify which populations are being marginalized and guides health leaders in targeting those groups. Monitoring inequitable disease distribution is one way that local health departments can counter outcomes of systemic racism.”

MCPHD sought input from and maintained regular contact with community partners among inequitably affected groups, such as the Black, Latinx, and Burmese populations.

These relationships helped determine targeted testing site locations in communities disproportionately affected by the pandemic.

For example, in May 2020, MCPHD opened testing sites at the largest predominantly Black church on Indianapolis’s Eastside and an educational campus with a large Latinx population.

Over time, MCPHD established a centrally located main testing site and opened and closed additional sites due to changes in incidence. Through the end of 2020, MCPHD operated at least three community sites at a time, with additional short-term, temporary sites used in response to COVID-19 surveillance trends.

“This intervention would not have been possible without community partnerships,” Caine emphasized. “These relationships need to be established and built upon for interventions such as this to be successful.”