The NYC Macroscope

New York City developed the NYC Macroscope, a population health surveillance system that uses electronic health records (EHRs) to track conditions managed by primary care practices that are important to public health.

Using the NYC Macroscope, we are able to monitor in real-time the prevalence of chronic conditions, such as obesity, diabetes and hypertension, as well as smoking rates.
For more information, see our three published papers below, or email nycmacroscope@health.nyc.gov.

How does it work?

The NYC Macroscope relies on data from the Primary Care Information Project which helps ambulatory providers in underserved areas adopt EHRs with population management tools to improve the quality of healthcare for the most vulnerable New Yorkers. 

The NYC Macroscope has been validated by comparing ambulatory EHR data with data from the 2013-14 NYC Health and Nutrition Examination Survey (NYC HANES 2013-14), a gold-standard, population-based health survey.  The lessons learned in developing the NYC Macroscope will be useful to other agencies and researchers interested in using EHRs to monitor population health.

Why use electronic health records?

Electronic health records (EHRs) are rapidly becoming the standard of care for office-based medical practices, as a result of federal incentive programs encouraging their uptake by health care professionals and institutions.  As of 2013 78.4% of office-based medical practices nationwide were using some kind of EHR system.

EHRs that have been constructed with population health management goals in mind can complement and expand the capacity of existing surveillance systems by capturing care events economically and with relative completeness.

About the project

The NYC Macroscope is part of a larger project, Innovations in Monitoring Population Health, conducted by the Health Department, the CUNY School of Public Health, and the NYU School of Medicine, in partnership with the Fund for Public Health in New York and the Research Foundation of the City University of New York.  Support for the larger project is primarily provided by the de Beaumont Foundation, with additional support from the Robert Wood Johnson FoundationRobin Hood, the New York State Health Foundation, and the Doris Duke Charitable Foundation.

Project Timeline

Phase I (completed June 2013):
Published Developing an Electronic Health Record-Based Population Health Surveillance System (PDF), a planning document to operationalize the NYC Macroscope and describe the methods to assess the validity of NYC Macroscope estimates.

Phase II (Completed June 2014):
Collected EHR data on priority health indicators:

  1. Chronic disease risk factors (blood pressure, body mass index, blood sugar, cholesterol)
  2. Chronic disease prevalence, treatment and control (hypertension, diabetes, high cholesterol)
  3. Behavioral health (tobacco use, depression)
  4. Receipt of clinical preventive services (influenza immunization)

Phase III (Completed December 2016):
Three papers describing the methods and findings of the NYC Macroscope were published in the December 2016 issue of the journal eGEMs.

Future Work

The NYC Macroscope team is examining the accuracy of neighborhood-level estimates, as well as estimates stratified by race/ethnicity to explore how the NYC Macroscope can be used to monitor health inequities. We are also studying EHR-based trends from 2012 to 2016 and comparing them with trends from established surveys.

Scientific Advisory Group

The NYC Macroscope was developed with input from the project's Scientific Advisory Group including public health professionals, clinicians and academics working in public health surveillance and informatics.

Maria Ayoob
Health Information Technology Transformation
New York State Department of Health 

Neil Calman, MD, ABFP, FAAFP 
Institute for Family Health

Ralph J. Coates, PhD 
Office of Surveillance, Epidemiology, and Laboratory Services
Centers for Disease Control and Prevention

Rich Elmore 
Allscripts

Marc Gourevitch, MD, MPH
Department of Population Health
New York University

Cristal Simmons, MPH
Chicago Department of Public Health

Patrick Remington, MD, MPH
University of Wisconsin School of Medicine and Public Health

David Ross, ScD
Public Health Informatics Institute

David Whitlinger
New York eHealth Collaborative

Tyler Williamson, PhD
Canadian Primary Care Sentinel Surveillance Network (CPCSSN)
Queens University

Resources