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 ( Committed to advancing informatics for a strong public health system 4

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 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 Context

Population health Public health Population health management Relevant Terms Population Health Population Health Population Health Management Public Health Public Health Clinical Care Health Department

Question How should public health informatics proceed in this age of Electronic Health Records and the Affordable Care Act? 8

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, challenges and strategies for moving forward Complete findings and plans will be forthcoming 9 Methods

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" 10

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 11

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 12

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 13

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

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