1. Public Health Data Standards Consortium http://phdatastandards.info http://phdatastandards.info

2. 1 PHDSC / eHealth Initiative Annual Conference May 2005, Washington, D.C. Public Health Participation in Health Information Exchanges: Barriers and Challenges to the Widespread Adoption and Use of Health Information Technologies Walter G. Suarez, M.D., M.P.H. President, Public Health Data Standards Consortium walter.suarez@sga.us.com 952-854-3401

3. 2 Barriers and Challenges u Most barriers experienced by Public Health in the adoption of HIT are similar to those experienced by clinical and administrative sectors in health care u Barriers can be organized into the following dimensions: Regulatory Organizational Cultural Financial Technical

4. 3 Barriers and Challenges - Regulatory u Lack of a clear mandate for public health to adopt national standards and interoperability across systems u Fragmentation in the requirements and relationships between Federal, State and Local public health agencies with respect to HIT

5. 4 Barriers and Challenges - Regulatory u Public Health functions respond to State/ Local requirements, enabling authorities, statutorily established responsibilities, and they vary from state to state u Variation in the adoption of a privacy framework for public health information, affecting the ability of agencies and organizations to adopt HIT

6. 5 Barriers and Challenges - Organizational u Fragmentation of categorical programs in public health, their interaction with clinical care and their data flows/data collection efforts u Lack of uniformity in the definition of public health business processes

7. 6 Barriers and Challenges - Organizational u Varying levels of HIT readiness across states and local agencies u Limited identification of ‘business cases’ in Public Health where the adoption and use of standards and health information technology demonstrate cost-benefits Most benefits are long term Most costs imply large upfront investment “Urgent need” not yet identified

8. 7 Barriers and Challenges - Cultural u Traditional separation between clinical practice, personal care and public health practice Varying levels of interaction and interdependencies between public health programs and clinical/personal care u Personnel readiness to adopt new technologies and standards

9. 8 Barriers and Challenges - Cultural u Difficulty in transitioning from a ‘batch’ mentality to a real-time approach to public health practice Few public health programs have taken advantage of HIT to transform their business processes into real-time or near- real-time data flows u Staff and organizational resistance to change

10. 9 Barriers and Challenges - Financial u Ongoing budget constraints and competing funding priorities in public health u Public health information infrastructures across states are under-funded and vulnerable to deeper funding cuts u HIT funding for public health continues to be programmatic and fragmented, creating “HIT-rich/HIT-poor” programs

11. 10 Barriers and Challenges - Financial u Limited funding commitment from public health for standards development efforts u Lack of model incentives to demonstrate value of investing in public health infrastructure and HIT u Shifting HIT priorities in response to new/changing national demands and federal requirements

12. 11 Barriers and Challenges - Technical u Infrastructure/Connectivity Issues Disparities in the availability and access to high- speed connectivity (rural vs urban PH programs) Dependency on low-speed connectivity between some public health programs and trading partners u Standards Issues Lack of standards for many electronic health information exchanges (e-HIE) in public health Existing standards for selected e-HIE in PH not widely adopted due to complexities, cost, modification of existing processes/systems, resistance to change

13. 12 Barriers and Challenges - Technical u Applications and Interoperability Issues Most public health applications are custom-developed and built to respond to unique program features Some can interoperate with internal systems within the agency Very few are capable of interoperating with external systems such as electronic health records u Human-ware issues Resistance to process changes Resistance to adopt and adapt to new technologies Resistance to larger reliance on HIT