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 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

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

Adapt work processes and work flow in software Medical record vs. reporting Standard Processes

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

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, 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 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 member Interfaces Evaluation of quality of care Public health partner Decision support Access to aggregate data

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 Direct Care Provider: Participant Member

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

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/ ) 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 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 Plan eHealth Council includes public health representation from both state and local level Public Health Workgroup Report submitted October 12 th 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

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

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

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

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

Future Share the burden Share the success Healthier people Healthier communities Access for all