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1
Public Health Informatics in the Age of EHRs and
the ACA Getting to Priorities
John W. Loonsk MD FACMI, Brian Castrucci, James
B. Sprague MD PHI Conference April, 2014
2
Our Mission and Funding Areas

• We believe in a strong governmental public health
  system
• We fund
• Training the public health workforce
• Building the public health infrastructure
• Improving information and data management

3
Our Principles

• Translating the theoretical to the practical
• Focusing on the boots on the ground
• Supporting projects that are
• Replicable
• Sustainable
• System-wide national impact
• Domestic focus

4
Related Activities

• With Duke and CDC, fostering public health /
  primary care integration though Practical
  Playbook project (practicalplaybook.org)
• Focused on public health workforce including work
  with the Public Health Informatics Institute
  (PHII) to help form Public Health Informatics
  Academy and the PHII Requirements Lab
  (www.phii.org/what-we-do)
• Committed to advancing informatics for a strong
  public health system

5
Context

• Public health informatics at critical juncture
• Over 70 of hospitals and 45 of community
  providers now have Electronic Health Records
  (EHRs) subsequent to over 30 billion in public
  incentive dollars
• Health departments not commensurately supported
  to participate in electronic interaction with
  clinical care
• Electronic Health Records (EHRs) do not address
  many population health functional needs

6
Context

• New clinical payment methodologies and the
  Affordable Care Act (ACA) are pushing clinical
  care organizations to address more population
  health functions
• Health is rapidly entering an era of big data
  and clinical care is the largest health data
  producer
• Jurisdictional, infrastructural, privacy, data
  and workforce challenges continue to face public
  health informatics

7
Relevant Terms

• Population health
• Public health
• Population health management

8
Question

• How should public health informatics proceed in
  this age of Electronic Health Records and the
  Affordable Care Act?

9
Methods

• Initiated interviews with senior thought leaders
• Convened 32 public health, clinical care, and
  health informatics leaders including senior
  representation from the CDC, ONC, ASTHO, NACCHO,
  CSTE and others Discussed industry trends, challen
  ges and strategies for moving forward
• Complete findings and plans will be forthcoming

10
Findings

• EHRs are only one of many important health IT
  applications
• Population health management and public health
  share a number of common functions
• Clinical care population health will principally
  focus on the 5 of patients who use 50 to 80 of
  health resources
• Health Information Exchange organizations are
  either "the answer for public health or are
  "dead"

11
Findings Information

• Public health access to EHRs, multi-payer claims
  databases, and reported data is frequently
  non-existent or problematic
• Factors involved in connecting to clinical care
  and low public health "Meaningful Use" reporting
  numbers are complex
• Basic case reporting still eludes automated
  clinical care public health exchange

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Findings Public Health

• Data sciences for big data clinical care
  analytics are not yet reconciled with
  epidemiology
• Needs for a "value exchange" / partnership
  between Accountable Care Organizations and public
  health
• Public health funding silos impede progress
• Health departments will continue to offer the
  jurisdictional denominator and complete
  population perspective

13
Initial Conclusions

• Needs for action
• Government HITECH and ACA efforts do not
  significantly advance informatics solutions for a
  strong, population-inclusive public health system
• Clinical care organizations and EHR vendors are
  early in consideration of population health
  functions

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Strategies

• Establish public health / clinical care value
  equation
• e.g. a public health ACO business contract
• Advance second generation approaches to accessing
  information
• e.g. role-based access "accounts" in EHRs for
  public health workers

Population Health
Clinical Care
Health Department
Population Health Management
Public Health
Data, Value, and Synergies
15
Strategies

• Help rationalize health department and population
  health IT
• e.g. sharing population health and public health
  reporting infrastructure
• Align population health incentives, funding and
  workforce
• e.g. help reduce barriers from silo'ed program
  funding

Population Health
Clinical Care
Health Department
Population Health Management
Public Health
Data, Value, and Synergies