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
H1N1What 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 H1N1What 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