Objective To evaluate the effect of implementing comprehensive, integrated electronic health record systems on use and quality of ambulatory care Design Retrospective, serial, cross sectional study. Setting Colorado and Northwest regions of Kaiser Permanente, a US integrated healthcare delivery system. Population 367 795 members in the Colorado region and 449 728 members in the Northwest region. Intervention Implementation of electronic health record systems. Main outcome measures Total number of office visits and use of primary care, specialty care, clinical laboratory, radiology services, and telephone contact. Health Plan Employer Data and Information Set to assess quality. Results Two years after electronic health records were fully implemented, age adjusted rates of office visits fell by 9% in both regions. Age adjusted primary care visits decreased by 11% in both regions and specialty care visits decreased by 5% in Colorado and 6% in the Northwest. All these decreases were significant (P < 0.0001). The percentage of members making ≥ 3 visits a year decreased by 10% in Colorado and 11% in the Northwest, and the percentage of members with ≤ 2 visits a year increased. In the Northwest, scheduled telephone contact increased from a baseline of 1.26 per member per year to 2.09 after two years. Use of clinical laboratory and radiology services did not change conclusively. Intermediate measures of quality of health care remained unchanged or improved slightly. Conclusions Readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality and allowed doctors to replace some office visits with telephone contacts. Shifting patterns of use suggest reduced numbers of ambulatory care visits that are inappropriate or marginally productive.

Public health surveillance is focused on the detection of acute, chronic, and emerging threats to the health of the population to direct disease control and prevention efforts. 1 Public health surveillance relies on health care providers to report to public health agencies conditions or outbreaks that may impact the broader population. This case reporting is mandated through laws and regulations at the state and local levels. Notification of cases to the Centers for Disease Control and Prevention (CDC) is facilitated by agreements between states and the federal government. 2 Historically, case reporting has been based on paper reports or Internet-based entry of reports to state health department systems, but these reports are often slow or incomplete and place a substantial burden of work on health care providers and public health agencies. 3 The future of surveillance is electronic case reporting (eCR), by which cases of reportable conditions are automatically generated from electronic health record (EHR) systems and transmitted to public health agencies for review and action. eCR holds promise for enhancing the quality and effectiveness of public health surveillance. 4 Greater use of eCR could result in (1) more complete and accurate case data in near real time for public health action; (2) earlier detection of cases, permitting earlier intervention and lowered transmission of disease; (3) improved detection of outbreaks to allow earlier investigation and, potentially, earlier identification of risk factors for the spread of disease; and (4) creation of a new infrastructure to support rapid reporting of newly recognized and emerging conditions. In this commentary, we review the promise of eCR and present our vision for a nationally interoperable eCR system that allows for timely reporting to public health and information sharing among jurisdictions. Coordination between health care providers and public health agencies is essential for the monitoring, control, and prevention of disease and is best carried out through a bidirectional exchange of information. In 2009, the US Congress passed the Health Information Technology for Economic and

In response to public concerns, 165 Meo Laotians had stools screened for intestinal parasites by the Illinois Department of Public Health. One hundred twenty-nine had at least one pathogenic parasite detected. Hookworm was detected most frequently, followed by Giardia lamblia, Trichuris trichiura, and Ascaris lumbricoides. Hookworm and overall infection were more frequent in persons 4 years of age and older, while giardiasis, ascariasis, and trichuriasis were most common in the 4- to 14-year age group. Most infections were helminthic and of no public health consequence in the United States. However, giardiasis was seven times as prevalent in refugee children as in the general US population, posing a potential public health risk in child-care settings.

Clinical documentation has dramatically changed since the implementation and use of electronic health records and electronic provider documentation. The purpose of this report is to review these changes and promote the development of standards and best practices for electronic documentation for pediatric patients. In this report, we evaluate the unique aspects of clinical documentation for pediatric care, including specialized information needs and stakeholders specific to the care of children. Additionally, we explore new models of documentation, such as shared documentation, in which patients may be both authors and consumers, and among care teams while still maintaining the ability to clearly define care and services provided to patients in a given day or encounter. Finally, we describe alternative documentation techniques and newer technologies that could improve provider efficiency and the reuse of clinical data.

An outbreak of group A β-hemolytic streptococcal infections involving three parturients, three newborns, and a nursery RN is reported. Six of six organisms available for serotyping were M-untypable, T-11, serum opacity reaction-negative. Propagation of the outbreak may have been fostered by the common use of a single sitz bath, although the evidence to support this is weak. The outbreak was rapidly controlled via strict cohorting, appropriate treatment and isolation of cases, and the routine use of triple dye for umbilical cord care.