This week is National Public Health Week (NPHW), celebrating the contributions of public health workers in communities all across the nation as they strive to improve the health of all of their residents. In commemorating National Public Health Week, the ePublic Health blog is highlighting some of the great successes achieved by three local health departments that are moving into 21st century healthcare through the use of EHRs.
This year’s theme, “Public Health is Return on Investment (ROI): Save Lives, Save Money” highlights the value of prevention and the importance of well-supported local public health systems that work to prevent disease and save lives. But achieving those goals are getting harder in the context of a fundamental fact that American healthcare costs continue to grow.
Local health departments play a vital role in the health and care of patients where they live. They provide unique services and have data reporting requirements to state and federal agencies. Clinical care and population-specific interventions are funded in a variety of ways and settings and many continue to face systematic funding challenges that complicate the delivery of their services.
Whether it’s at the municipal, county, state or federal level, these organizations provide coordinated care to some of the country’s most vulnerable citizens. And one tool used by these departments to improve population health is Electronic Health Records (EHRs). EHRs already play a vital role in helping prevent disease and save lives while working to coordinate care and help control healthcare costs for underserved populations across the country.
Otter Tail County, Minnesota
In Fergus Falls, MN, the Otter Tail County Public Health Department predominately serves adults who are enrolled in the county’s medical assistance program.
“Most of our clients have chronic health and comorbid conditions,” explains Diane Thorson, the Director/CHS Administrator at the department.
“The best value or ROI due to the recent implementation of the EHRs is the ability to query information regarding whether clients have had the appropriate immunizations such as flu, pneumonia, TDAP, and Zostavx,” Thorson says.
Thorson said she believes the ability to quickly obtain aggregate data through the EHR is important. The EHR, she says, describes outcomes of care rather than the numbers of units of service and helps the department avoid duplicate immunizations. It gives the health workers the ability to “guide evidence-based practice.” Otter Tail’s team uses tools available from the Public Health Informatics Institute (PHII) and talks with colleagues at other departments to guide decision making and exchange lessons learned.
Through the use of the EHR, the Otter Tail health department has been able to better manage and coordinate care for patients who rely on the care provided by doctors and nurses in the county health department.
District Health Department 10, Michigan
The District Health Department #10 (DHD10), which is responsible for 10 counties in Michigan, serves a similar underserved population as the Fergus Falls health department. More than half of the people DHD10 serves (54 percent) live in rural areas and are at, or slightly above, the national poverty level. With an unemployment rate of about 15 percent, about 55 percent of births in the counties DHD10 serves are reimbursed by Medicaid.
According to Sheryl Slocum, the EHR Liaison/Family Planning Supervisor for District 10, many of their patients have co-morbidities and unhealthy lifestyle habits. The population struggles with obesity, smoking and abusive behaviors.
Because of the diversity and difficulties in treating its residents, District 10’s Family Planning and Breast and Cervical program has 10 local sites which patients can use, each with connection to the LHD-wide EHR system.
The benefits of this portability are telling, according to Ms. Slocum. Quality assurance activities are now more efficient. While quality improvement activities are underway, it is expected that the EHRs will make processes more efficient and streamlined.
Cabarrus County, North Carolina
Since the fall of 2011, the Cabarrus Health Alliance (CHA) of North Carolina has been systematically implementing an electronic health record, Insight, throughout the clinical and support areas, according to William Pilkington, CEO and public health director.
The patients Cabarrus serves often can’t afford health insurance or treatment and many of these low-income patients live with multiple social stressors that often compound their existing medical conditions.
A particular area of specialty for CHA is high-risk maternity patients. Although maternity patients are seen in the clinic daily, given the clinic’s staffing issues (only one obstetrician), deliveries are often handed off to experienced OB/GYNs who work at the local hospital.
Before the alliance adopted the use of EHRs, it was common for patients to receive additional tests and more extensive pre-natal exams when they arrived at the hospital, because their medical records didn’t travel with them. While it is critical to have this information if a mother delivers early, this is precisely when the paper system was most likely to break down, Pilkington explains.
Now, a mother’s medical record is available to labor and delivery staff at any hour on any day of the week, even when the delivery is unexpectedly early, thanks to the EHR.
The EHR has also made it possible for clinicians to automate best practices throughout the Alliance’s facilities, such as in CHA’s Pediatric Clinic in Kannapolis, NC. The American Academy of Pediatrics instituted its Bright Futures curriculum in 2011. Bright Futures is a national health promotion and disease prevention initiative which includes extensive, evidence-based preventive services recommendations for pediatric practices. Recommended screenings and services are now automated by the EHR which presents age-appropriate material based on the curriculum.
Mothers and their newborns who are treated by the Cabarrus Health Alliance can be assured that their records will provide their doctors with the right information they need where they need it, thanks to the adoption of EHRs across the county facilities, helping to make the care they receive that much more efficient.
The Return on Investment for Public Health
While ROI is typically thought of in a purely business sense and revolves around financial gain, many local health departments are actively demonstrating that EHRs can provide a return on investment in different ways. These tools have been proven to help connect patients with needed health and social services in Cabarrus County and ten counties in Michigan. They are streamlining processes and saving valuable time in Otter County.
But one thing is clear, those departments that are using EHRs won’t be going back to paper records because they are seeing the benefits of health IT. They are demonstrating that Public Health ROI does save lives and money – goals that are worth celebrating during National Public Health Week.
A special thanks to Kathy Cook, Diane Thorson, Sheryl Slocum, and William Pilkington for their
contributions to this post.
At Stage 2 it’s all about achieving interoperability through common standards among diverse systems and organizations exchanging information. 
By Dr. Phred Pilkington Chief Executive Officer & Director of Public Health Cabarrus Health Alliance
