1. Engagement in Health Information Technology and Health Information Exchange Efforts: Is there Public Health-Healthcare Collaboration? Victoria Wangia, Phd. MS. University of Kansas Medical Center - Center for Healthcare Informatics
OBJECTIVE
To assess whether public health organizations and professionals are collaborating with healthcare in health information technology (HIT) and health information exchange (HIE) initiatives.
Identifying where collaboration through contributions made, noting a main lesson learned and a challenge, and noting benefits of collaborating.
Assessing whether PHIN best practices, standards and applications are being applied in the HIT and HIE context
Making recommendations on where collaboration and public health engagement is still needed
METHODS
Literature Review
Environmental Scan
Interviews
RESULTS
Though the public health information network (PHIN) is well understood and applied by public health organizations, there was no explicit mention of PHIN in relation to the HIT and HIE efforts, and there was no explicit evidence of how PHIN was being integrated into the HIT and HIE efforts.
Key initiatives that demonstrate public health’s contribution through collaboration with healthcare in HIT and HIE efforts were identified:
In 2005, RWJF supported InformationLinks grants for projects demonstrating connecting public health with HIE – to help public health agencies participate fully in the development of HIE
Grantees: public health institutes, local health departments, universities and other nonprofits
InformationLinks Community of Practice was formed
Kickoff meeting: February 7, 2008
CDC, RWJF and Public Health Informatics Institute initiative
Vision includes:
Promoting health information exchanges (HIEs) between  public health systems and private healthcare
Encouraging knowledge and expertise sharing, collaboration, and solution building to improve public health systems’ exchange of health information
Developing public health systems’ organizational capabilities to develop, maintain and participate in HIEs
Presentations reveal the value of collaboration. Some examples include:
Dr. William D. Hacker’s presentation on “The Role of Public Health in Electronic Health Exchange” – March 30, 2007, to State Alliance for e-Health
2008 AMIA Spring Congress Presentations
Public Health Informatics Track
Collaboration through the Office of the National Coordinator of HIT (ONC) initiatives is evident. Examples:
American Health Information Community (AHIC):
Members are leaders committed to the advancement of HIT: Julie Gerberding, M.D. – AHIC member, and NCPHI director also involved in providing recommendations to the Secretary of DHHS.
Breakthrough area - Biosurveillance
Biosurveillance data steering group formed as a sub-group within the Biosurveillance Workgroup and Confidentiality, Privacy & Security Workgroup.
January 23, 2007: AHIC renamed the Biosurveillance Workgroup to Population Health and Clinical Care Connections Workgroup.
Workgroup charged to make recommendations to the AHIC to facilitate the flow of reliable health information among population health and clinical care systems necessary to protect and improve the public’s health
Health Information Security and Privacy Collaboration (HISPC) – ONC project
Individuals engaged from public health departments
Public health scenarios examined
Public Health Standards Data Consortium (PHDSC) PRISM privacy and security tool for public health professionals was developed with input from HISPC work
Healthcare Information Technology Standards Panel (HITSP)
Harmonizes and integrates standards that will meet clinical and business needs for sharing information among organizations and systems.
The biosurveillance interoperability specification defines specific standards that promote the exchange of biosurveillance information among healthcare providers and public health authorities.
ABSTRACT
As health information technology is adopted and health information is exchanged, public health and healthcare organizations must work collaboratively for these efforts to be a success. This assessment aimed at identifying health information technology (HIT) and health information exchange (HIE) initiatives that demonstrated collaboration between public health and healthcare entities, selecting those where the contribution by public health organizations and professionals were significant. Consequently, gaps were identified, a major challenge of collaboration and lesson learned from collaboration was noted, and whether any aspects of PHIN were integrated into the identified efforts was assessed. Benefits of collaboration were also identified. Interviews, an environmental scan and literature review informed this assessment. There was sufficient evidence to conclude that public health is engaging and being engaged in HIT and HIE efforts at both the national and the state levels. However, though public health was engaged, there was no explicit mention of PHIN, and no evidence of how PHIN best practices, standards and applications were being integrated into the HIT and HIE efforts. Collaboration that explicitly demonstrates projects integrating relevant aspects of PHIN into HIT and HIE efforts would be highly desirable. This assessment also revealed and recommended other areas that need more collaboration.
INTRODUCTION
Adoption of HIT and secure exchange of health information continue to be promoted.
The benefits of adopting HIT and exchange of health information outweigh the risks.
Collaboration between public health and healthcare organizations in HIT and HIE efforts is critical. The value of the collaboration is summarized in Table 1.
Table1. Lists the value of public health-healthcare collaboration in HIT and HIE efforts.
In March 2008, CDC awarded 3 contracts for 5 years for the development of the Nationwide Health Information Network (NHIN) - $38 million
Centers of Excellence in Public Health Informatics funded by CDC in 2005
Contributing through projects that:
Demonstrate electronic health record support of public health functions.
Use health care, population and other public health data in supporting public health systems and analyses.
PHDSC taskforce’s white papers on public health and EHRs, and on building a roadmap for HIT interoperability for public health.
Specific examples of contributions through collaboration at the state level exist. Examples:
Kansas
InformationLinks grantee
Interface developed for two-way real-time exchange of immunization data between the statewide immunization registry and clinical information systems
Involvement of state health department and coordinator of public health informatics in ONC HISPC project
New York
New York City health department – CDC NHIN contract
Working with county health departments and regional health information networks to develop a network for detecting disease outbreaks or bioterrorism incidents and tracking contagious diseases
CONCLUSIONS
Public health contribution in key HIT and HIE initiatives is evident, however, the challenge of needing to continue to demonstrate the added value that public health brings still remains. A popular lesson learned by many was to stay involved and be prepared to articulate the significant contributions public health bring, continuing to seek for opportunities for engagement.
The assessment identified gaps, revealing where collaboration was needed. These included, to:
Integrate lessons learned from PHIN efforts into HIT and HIE efforts, and to consider PHIN applications, practices and standards
Involve public health more in assessing privacy and security concerns specific to secondary use of electronic health data and other exchanges of healthcare data
Involve healthcare in identifying useful electronic public health data and initiating development of interfaces to allow for efficient exchange of data
Involve public health in promoting the use of personal health records (PHRs) and the public health benefits
Involve public health in the development of personal health records (PHRs), and in decisions on the types of health information to include in the PHR
Involve more state and local health departments in the efforts
Value for Healthcare has been reported to include:
Value for Public Health has been reported to include:
Providing data for improved diagnostic accuracy – such as epidemiological data
Reducing cost and labor of mandated reporting
Offering personalized information that facilitates disease management and care coordination
Providing individual patient information – immunizations, lab results etc.
Easy access to guidance for managing public health problems
Personalized point-of-service tools for diagnosis or patient education
Automated tools for quality improvement – immunization audits
Alerts for providers – air quality alerts for providers
Maintaining participant directories, security, community master patient index
Providing an accountable point of person for community or political leaders
Access to public infrastructure resources
Trusted neutral manager for confidential information
Accessing more comprehensive data for secondary use
Authorities kept informed of hospital bed availability and the status of other resources in the event of an emergency
Faster transmission of better information
Providing individual patient information – immunizations, lab results etc
Analyzing and displaying geographic distribution of disease to focus public health interventions and services
Improving communication with selected patients and providers
Emergency preparedness planning and resource allocation
Easier gap analysis of preventive health services, and identification of patterns that could improve performance
Helping to identify disease outbreaks
Tracking chronic diseases an health issues in communities
Better reporting processes are expected with timely and available access to data and improvements to accuracy of data