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

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

2. PHDSC / eHealth Initiative Annual ConferenceMay 2005, Washington, D.C. Public Health participation in health information exchanges: Accelerating adoption and widespread use of HIT David A. Ross, Sc.D. Director, Public Health Informatics Institute

3. Public Health Mission • Institute of Medicine – “what we, as a society, do collectively to assure the conditions in which people may be healthy.” • Public health must be a partner to fulfill its mission • Mandated to protect and improve the health of all people within a legal jurisdiction • Public health informs, coordinates care and resources, and regulates • Effective public health requires an understanding of the interdependent nature of its functions with those of the health care system

4. What can public health bring to the party? • Information intensive business • Surveillance systems • Case management systems • Environmental monitoring systems • Emergency response and coordination systems • Agent for transforming data into information • Analytical methods and epidemiology as core competencies • Data warehouse capabilities • Preventive service guidelines • Neutral convening authority • Governmental entities charged with improving everyone’s health

5. Where public health adds value to HIE • Provider of patient information and direct services • Immunization registry data and decision support • Laboratory analysis, results reporting and population-based analysis and recommendations • Care coordination for children with special healthcare needs • Provider of epidemiologic information to improve diagnostic accuracy and treatment decisions • Outbreak alerts • Patterns of drug-resistant organisms within a community • Trends that spark community collaboration on new health initiatives • Inform health payor planning

6. Where public health adds value to HIE • Convenient access to guidelines and recommendations • Infection control practices • Screening recommendations, etc. • Point of service tools for diagnosis or patient education • Guidelines embedded in EHR’s sensitive to local prevalence and service information • Screening reminders for local at risk groups • Information for patients in need of supportive social or other services – e.g., children with special needs, rehab services, etc. • Automated tools for quality improvement • Immunization audits of office practices • Newborn screening follow-up (e.g., sickle cell) and care coordination

7. Where public health benefits • Timely disease reporting • Improved case management and care coordination • Communicable disease patient management (e.g., TB) • Newborn screening follow-up • Improved analysis of patterns of care and gaps in delivery of preventive services • Closer working relationship with health care delivery partners

8. Challenges for public health • Leadership • How to counteract the instability of politically appointed leaders? • How to balance regulatory roles with community partnership? • Can public health play a role in governance? • Financing participation • Legislatures direct activity through appropriations – what level of commitment must public health bring to the information exchange? • Business-like data trading partnership • Can public entities link systems with reliable performance? • Can the heath care provider count on public health data quality and availability?

9. How to accelerate public health participation? • Uniform, sustainable and modern information infrastructure • Uniformly definition of public health business processes • Base level of nationally adopted information system requirements derived from core business processes • Financial commitment • Infrastructure must be supported as a core cost of doing business,not as an annually appropriated activity that competes with other programs • Continuous participation in national standards setting bodies • Collaboration to bring clear, defensible positions that argue for specific standards on behalf of the public health enterprise

10. Why requirements are so important for public health to be a member of the HIE • Health information exchanges will depend on viewing each member as a node • Public health needs an integrated information architecture and infrastructure at local and state levels • Public health agencies do not presently hold a common understanding nor articulation of their information system requirements, except for specific application areas (e.g., infectious disease surveillance) • Logical conceptualization of requirements established around a framework of business processes will enable public health to build a sustainable and rational information infrastructure

11. Questions? Dave Ross DROSS@PHII.org www.phii.org 404-687-5634