Local Health Department Perspective

1. Local Health Department Perspective Electronic Medical Record Software and Health Information Exchanges • Kathleen Cook • Information & Fiscal Manager, Lincoln-Lancaster County Health Department • NACCHO Representative to PHDSC

2. LHDs have two perspectives • Direct care provider • Public health authority

3. Direct Care Provider • Support direct service efficiently • Reduce errors • Support quality assurance and improvement efforts • Facilitate transfer of information needed to provide care • Laboratory testing • Referrals • Prescriptions

4. Direct Care Provider: • Eliminate paper records • Promote consistency and quality of care • Improve ability to monitor performance • Communicate accurately and quickly • Measure outcomes and monitor indicators

5. Selecting & implementing Electronic Medical Record • CCHIT certified • Master patient index • Off the shelf • No or very limited customization • Training / Informatics competencies of front line staff

6. Selecting & implementing Electronic Medical Record • Adapt work processes and work flow in software • Medical record vs. reporting • Standard Processes

7. Public Health Authority • Surveillance and response • Health status and disease monitoring • Population-based health care / quality improvement • Health care access and utilization • Health education & communication • Population-based research

8. LHD as Public Health Authority: What we need • Access to aggregate data • Access to near real time data for reportable diseases • Access to near real time surveillance information • Identification of populations at risk • Access to immunization information

9. LHD as Public Health Authority: What we provide • Advisories regarding events, outbreaks • Identification of populations at risk • Guidelines, recommendations, schedules • Analysis of quality measures • Case & syndrome definitions • Diagnostic guidelines & criteria • Coordination and facilitation of scarce community resources

10. Opportunities / Challenges • HIT Stimulus funding • State eHealth Plan • HIT Resource Center • Local / State Health Information Exchange • Electronic Medical Records

11. Health Information Exchange • Participant member • Interfaces • Evaluation of quality of care • Public health partner • Decision support • Access to aggregate data

12. Direct Care Provider: Participant Member • Health information exchange • Laboratories • State immunization registry • Dentrix (in-house dental software) • Pharmacy • Consults & referrals • Case management partners • Health care access referrals • Dental provider referrals and partners

13. Public Health Partner • To develop meaningful use functionality • Clinical decision support • Meet public health objectives and measures • Immunization • Public health alerts • Population measures • Surveillance measures • Clinical and community dashboards

14. H1N1—What we could have done IF… Local HIE • Vaccine need / distribution • Determine population at highest risk by provider (phone/fax/mail) • Distribute vaccine and notify high risk patients where/how they can obtain (provider office contacted) • Decision support • Provide alert to physician at point of service (physician advisory-fax/ e-mail) • Community Health Status • Incidence of flu-like illness and level of severity (sentinel physicians, school absenteeism) • Providers update state immunization registry (LHD providing data entry) • LHD estimate immunity levels in the community • Overall • High risk populations

15. Public Health: H1N1—What we were able to do with EMR • Set up phone bank and schedule people for appointments • Export all H1N1 immunization information to state registry electronically • Report #s by risk and age categories

16. State eHealth Plan • eHealth Council includes public health representation from both state and local level • Public Health Workgroup Report submitted October 12th included: • Assessment of data available from EMRs that public health needs • Information public health can provide for clinical support • State of readiness of public health to accept / exchange information electronically • Relationship to national discussion regarding meaningful use • Recommended stage approach to interoperability between public health and EMR/HIE systems • Identified barriers / challenges for public health

17. Staged Approach • First stage • Immunization • Reportable disease • Syndrome surveillance • Second Stage • Public health disease registries

18. Staged Approach • Third stage • Develop chronic disease registry • Fourth Stage • Knowledge management • Evaluate quality and effectiveness of health care system • Decision support

19. Return on Investment • Evaluate technologies and cost effectiveness for implementation at state or local level • Improve response capacity and effectiveness (Response is always local) • Public health critical to assuring all providers can meet meaningful use criteria • Reduction of time & effort by provider for required reporting • Access to public health advisories, guidelines and recommendations • Participation & access to quality of care review & analysis • Access to immunization histories

20. Challenges • Public health infrastructure and capacity varies widely • Few EMRs come “off the shelf” with interfaces for key public health reporting systems • Public health systems still siloed within program areas • Privacy & Security • Cost: dollars, time and human resources • Expectations about timeliness, quantity and relevance of data

21. Future • Share the burden • Share the success • Healthier people • Healthier communities • Access for all