Recently Vanessa Holley and I were asked to facilitate a workshop with local health departments (LHDs) in Kansas. We were slated to discuss how to help LHDs make two decisions:
- Do they need an electronic health record (EHR) system?
- If/how should they connect to the health information exchange (HIE)?
Through the course of the discussions, it quickly became apparent that the decisions to have an EHR or connect to the HIE were only part of the story and in some ways were over emphasized because they are easier to conceptualize. But the discussions began to broaden and clarify some of the issues. As it turns out, I think we actually stumbled upon a pretty good road map for ePublic Health.
Let’s look closer at what I mean.
Before you can effectively take advantage of any technology or HIE option:
- Step 1: develop the future vision for your LHD and clarify both what value and what services you plan to offer your community. You first need to determine what services your LHD will be focused on in the new world of healthcare. This is critical because if, for example, your health department is not going to continue to heavily invest in clinical services, then considering a practice management or EHR system may not be a good investment – despite current needs. On the other hand if you plan to increase your case management and care coordination role in the community, you’ll want to be sure whatever system you purchase or build takes into account those requirements in order to best support your work.
- Step 2: is to create or update your statewide collaborative Health Information Management Plan and planning body with a wide representation from LHD, state, and program personnel. Even if this already exists, ensure that representatives are both well informed and doing a complete job of communicating out decisions that are made. To begin this step you have to begin to coordinate at a heightened level with your state and neighboring LHDs. In Kansas, they have had a great relationship with their state and a very active LHD association. However, they still realized that they could benefit by making a more formal body that is charged with coordinating and collaboratively developing the Health Information Management Plan for public health. This is different from the statewide HIT plan because it is much more than information technology and is solely focused on creating one public health voice for health departments throughout the state. This is so critical because your partners need to hear a coordinated and unified voice for public health. Also, most of the Meaningful Use solutions are designed and managed at the state level. Therefore it is imperative that LHDs are collaborating with the state to understand how their information needs will be met and how these solutions will interact with their local systems. There has been so much to keep up with in the fast pace of Meaningful Use that many states have not yet formalized this body and its charge. However states that have recently created such a coordinating body, like Ohio, report huge successes in making decisions and dealing with unforeseen issues related to the changing world of ePublic Health (See CDC Charter Lite Template).
- Step 3: gain a clearer appreciation for your LHDs capabilities, needs, and desires. This can often involve an assessment of the systems you have, the needs that are met and the gaps that exist. It might even be good for the aforementioned Health Information Planning group to survey LHDs and display results. This will help LHDs identify peers they can work with and peers who can offer peer assistance or advice about vendors. It is important that this not be done from a standpoint of competition or condemnation, but rather of bettering each health department.
- Step 4: delineate the benefits of practice management and EHR systems. Though clinical operations and responsibilities for LHDs can vary wildly, most LHDs have some sort of specialty clinics that they run (examples include STD/HIV, TB, Maternal and Child Health, etc). And though the state is often preparing systems to meet Meaningful Use requirements, LHDs must come up with their own solutions for meeting the demands of these clinics. Complicating matters, LHDs often have cross over between local clinic information needs and programmatic reporting to state or federal partners. In our discussions in KS, we discovered that even with smaller programmatic clinics there are good reasons to deploy one or both of these types of systems. Especially since costs have decreased dramatically in the past 5 years. Benefits include more efficient programmatic reporting, increasing overall clinic efficiency resulting in a higher volume of visits, increased recovery of costs and billing, decreased need for record space, etc. Once you have determined that the benefits offered by these systems fit within your LHD vision, conduct a review of specific systems based on your unique requirements, and understand the costs and benefits you can expect, then you can make an informed decision as to which system you should deploy (see NACCHO’s All-Systems-Go tool).
- Step 5: know your requirements for exchange and assess/pursue your local HIE options to support those requirements. For this final step, our discussions in KS turned to the HIE options that exist in their state. Since they have been a leader in Health Information Exchange and LHDs have been heavily involved, they have a couple of really nice options. In their state, LHDs can get basic HIE services for free, which include direct secure messaging and access to a provider web portal. And KS LHDs are finding really interesting ways to use these services – like using the web portal for case investigations and sending follow-up testing requests and outbreak summary reports to physicians using direct secure messaging. The state health department is working to connect their reporting systems to LHDs through the HIE, but work remains to make local and state systems interoperate in this fashion. It also came to light that there were other exchange requirements that the LHD had that aren’t a part of their “free” set of services, but have enough value that they will want to understand the costs/benefits and pursue those options. For example, local clinic managers would like to perform clinical assessments on their clients and provide test results and other clinical notes to the referred provider or receive visit summary documents when the referred visit is complete. Though there is still much work to do, what was clear was that in the not so distant future one could imagine LHDs in KS having an efficient and interoperable connection to the state and other community based systems through their HIE. In order to have this sort of success, it is critical that your LHD get involved, stay involved, or increase involvement locally with your HIE options. Be aware of what services your HIEs provide, how these services can benefit your LHDs vision for the future, and see if you can negotiate special rates for LHDs.
If LHDs earnestly and systematically pursue these five steps, I believe they will have a thriving and successful transition into becoming an efficient LHD of the ePublic Health future. At NACCHO, we’re working with our ePublic Health workgroup to develop more detailed tools that will support LHDs who go through each of these steps – so stay tuned. I want to give a special thanks to the Kansas Health Foundation, Kansas Association of Local Health Departments, and Kansas Department of Health and Environment for allowing me into their rapidly developing world of ePublic Health.