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

LHDs have two perspectives

Direct care provider

Public health authority

Direct Care ProviderSupport direct service efficientlyReduce errorsSupport quality assurance and improvement effortsFacilitate transfer of information needed to provide care

Laboratory testingReferralsPrescriptions

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

CCHIT certified

Master patient index

Off the shelf

No or very limited customization

Training / Informatics competencies of front line staff

Selecting & implementing Electronic Medical Record

Selecting & implementing Electronic Medical Record

Adapt work processes and work flow in software

Medical record vs. reporting

Standard Processes

Public Health AuthoritySurveillance and responseHealth status and disease monitoringPopulation-based health care / quality improvementHealth care access and utilizationHealth education & communicationPopulation-based research

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

Advisories regarding events, outbreaksIdentification of populations at riskGuidelines, recommendations, schedulesAnalysis of quality measuresCase & syndrome definitionsDiagnostic guidelines & criteriaCoordination and facilitation of scarce community resources

LHD as Public Health Authority: What we provide

Opportunities / Challenges

HIT Stimulus funding

State eHealth Plan

HIT Resource Center

Local / State Health Information Exchange

Electronic Medical Records

Health Information Exchange

Participant memberInterfaces

Evaluation of quality of care

Public health partnerDecision support

Access to aggregate data

Health information exchangeLaboratories

State immunization registry

Dentrix (in-house dental software)

Pharmacy

Consults & referrals

Case management partners

Health care access referrals

Dental provider referrals and partners

Direct Care Provider: Participant Member

Public Health PartnerTo develop meaningful use functionality

Clinical decision support

Meet public health objectives and measuresImmunizationPublic health alertsPopulation measuresSurveillance measuresClinical and community dashboards

Vaccine need / distributionDetermine 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 supportProvide alert to physician at point of service (physician advisory-fax/ e-mail)

Community Health StatusIncidence 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

OverallHigh risk populations

H1N1—What we could have done IF… Local HIE

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

State eHealth PlaneHealth Council includes public health representation from both state and local levelPublic Health Workgroup Report submitted October 12th included:

Assessment of data available from EMRs that public health needsInformation public health can provide for clinical supportState of readiness of public health to accept / exchange information electronicallyRelationship to national discussion regarding meaningful useRecommended stage approach to interoperability between public health and EMR/HIE systemsIdentified barriers / challenges for public health

Staged Approach

First stageImmunization

Reportable disease

Syndrome surveillance

Second StagePublic health disease registries

Staged Approach

Third stageDevelop chronic disease registry

Fourth StageKnowledge management

Evaluate quality and effectiveness of health care system

Decision support

Return on InvestmentEvaluate technologies and cost effectiveness for implementation at state or local levelImprove 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 reportingAccess to public health advisories, guidelines and recommendationsParticipation & access to quality of care review & analysisAccess to immunization histories

ChallengesPublic health infrastructure and capacity varies widelyFew EMRs come “off the shelf” with interfaces for key public health reporting systemsPublic health systems still siloed within program areasPrivacy & SecurityCost: dollars, time and human resourcesExpectations about timeliness, quantity and relevance of data

FutureShare the burden

Share the success

Healthier people

Healthier communities

Access for all