Opportunities In Public Health Reporting And IT Systems

By Megan Williams, contributing writer

The discussion around EHR (electronic health records) has gone well beyond documenting patient encounters. Records are being used to track trends not only in individual patient health, but also to document and anticipate public health trends.

The Office of the National Coordinator for Health Information Technology (ONC) released a brief last month on public health reporting and information systems, titled, Health IT for Public Health Reporting and Information Systems. The issue brief covers progress in the area of electronic public health reporting and explores opportunities to improve information systems and public health reporting processes.

What’s Happened So Far?

The report provides a chart, breaking down Meaningful Use stages (so far, only Stage 1 and Stage 2), by five public health measures (immunization information, electronic laboratory results, syndromic surveillance, cancer registries, and specialized registries) and indicating which healthcare entities (eligible providers, eligible hospitals, and critical access hospitals) are required to participate in each.

A visual is available (Fig 3. Percent of Participating Eligible Hospitals Selecting at Least One Public Health Measure), of the geographic breakdown of the adoption of the use of electronic public health records for population health. Some of the results provided include:

• 62 percent of the total volume of lab reports were sent electronically
• 54 percent of targeted labs were sending lab reports electronically
• 13 states and one city were sending over 75 percent of their total volume of lab reports electronically
• 17 states and one city were sending 50 to 75 percent of their total volume of lab reports electronically
• HIV, lead/toxic, and STD electronic lab reports were the disease categories with the greatest number of lab reports, each area with over 2.5 million reports sent electronically in a 12 month period.

What Are The Opportunities?

The ONC is working alongside public health agencies, the CDC, EHR vendors, and a mix of other stakeholders in their development of consensus-based implementation guides. These guides promote standards for the design and implementation of interoperable systems.

Collaboration with Health Information Exchanges is also discussed. These exchanges have access to information from entities including hospitals, providers, laboratories, and pharmacies and the ONC is serving as a force to organize the connection of disparate stake-holders at the state level. This process is already going on in Virginia and Mississippi.

The report also addresses the establishment of the ONC-led initiative to use distributed networks in the analysis of data from multiple organizations for secondary uses including disease surveillance, comparative effectiveness, and medical product safety. This is addressed under the Data Access Framework (QueryHealth) initiative. The concept has already been used in addressing obesity rates in the state of New York (Figure 4).

Perhaps most valuable to VARs, is the section on page 11 that addresses Medicaid 90/10 funding opportunities for public health infrastructure. The report acknowledges the need for technical and administrative infrastructure to receive the data needed to achieve program goals. Real-time data collection will need to become the norm, and agencies are currently working to build infrastructure that can support the necessary types of feeds. Through the Medicaid Electronic health Record Incentive Program, public health agencies can receive up to 90 percent federal matching funds through HITECH (Health Information Technology for Economic and Clinical Health) administrative funding.

What Are The Concerns?

The report emphasizes three key areas of concern:

• The volume of data coming in to public health agencies and the infrastructure needed to support an increase
• The development of an on-boarding processes around Meaningful Use Stage 2
• The development of sustainability plans at the state and local levels to address long-term investment capability

What’s Next?

The introduction of Meaningful Use programs has given birth to cooperative communities of policy-makers, implementers, state and local public health, and other invested individuals. As Stage 3 policy is being developed teams will continue to create public health use cases around standards including Data Access Framework, Structured Data Capture and Health eDecisions. End-to-end testing of the comprehensive implementation guide will be performed, which will likely present opportunities for interested solutions providers.