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HIT and Interoperability Initiatives: Assuring a Role for the LHD SafetyNet. presented at the National eHealth Collaborative August Board of Directors Meeting Thursday, August 13, 2009 by: Yvonne Claudio, DM, MS. The National Association of County and City Health Officials

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HIT and Interoperability Initiatives:

Assuring a Role for the LHD SafetyNet

presented at the

National eHealth Collaborative

August Board of Directors Meeting

Thursday, August 13, 2009


Yvonne Claudio, DM, MS

The National Association of County

and City Health Officials

NACCHO supports efforts that protect and improve the health of all people and all communities…

promotes national policy

develops resources and programs, seeking health equity

supports effective local public health practice and systems

represents approximately 3,000 LHDs across the US

LHD—A Key Safety Net Provider

Facilities in medically underserved communities….

Local health departments (via health centers/clinics)

Community health centers (FQHCs and FQHC Look Alikes)

Independent clinics and health centers

Free clinics

Clinics in schools, homeless shelters, housing projects

Public hospitals

Source: Institute of Medicine, 2000 America’s Healthcare Safetynet: Intact but Endangered.

Patient Population/Communities Served

LHDs deliver health care to patients who are...


medically uninsured/underinsured

Medicaid covered


chronically sick

with inadequate access to health care resources

facing barriers to care (language, cultural issues)


experience disparities in health status and quality of care

SafetyNet Role Aligns with

Public Health Core Functions/Essential Services


Monitor health status

Diagnose and investigate health problems and health hazards

Inform, educate, and empower people about health issues

Mobilize community partnerships to identify and solve health problems

Policy development--

Develop policies and plans that support individual and community health efforts

Enforce laws and regulations that protect health and ensure safety


Link people to needed personal health services and assure the provision of health care when otherwise unavailable

Assure a competent public health and personal health care workforce

Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Research for new insights and innovative solutions to health problems

Comprehensive Primary Care Services

# LHDs % Providing Primary Care

LHD Population 11%

<25,000 930 7%

25,000-49,000 490 9%

50,000-99,999 346 16%

100,000-499,999 400 16%

500,000+ 127 25%

Guesstimate: 260 LHDs provide primary care

@ 2 clinics each--520 health centers

@ 5 clinics each--1,350 health centers

Source: NACCHO, 2008 National Profile of Local Health Departments, July 2009

Philadelphia Department of Public Health

(sample SafetyNet LHD)

8 FQHC Look-Alike Centers

located in poorest, medically underserved areas

City Stats

Population--1.5 million

Persons below poverty level--24% or 360,000 residents

PDPH Patient Stats

80,000 patients (180,000 visits per year)

Sites serve approximately 1/4 of the City’s poorest residents

57% are uninsured; 24% have Medicaid coverage

LHDs—Add’l Health Services

Population in Jurisdiction


Family Planning 59% 62% 66%

Prenatal Care 37% 42% 40%

Oral Health Care 33% 43% 57%

Mental Health 12% 13% 27%

Substance Abuse 8% 9% 24%

Home Health 26% 18% 11%

Source: NACCHO, 2008 National Profile of Local Health Departments, July 2009

Maintaining Community’s Health

(Sample Listing of Services)

Prevention and Treatment…


Lead Screenings

Communicable Disease

Nutrition Services

Substance Abuse

Mental Illness

HIT Supporting Clinical Services



Pharmacy Information System

Automated Lab System

Digital Radiology System (x-rays, mammography)

Case Management System--to track/manage pts

Social Services/Benefits Counseling system

Practice Management System

Web-based Resources

Smart Card/Mobile Solution

HIT Supporting Public Health Services

Surveillance systems

Case management systems/registries

Laboratory information systems

Electronic vital records

Animal control IT

Medical examiner IT systems

Web-based and mobile systems

—for informing, alerting, response, reporting

Challenges to HIT Adoption/Interoperability

Scarce resources/funding cuts

tight budgets

limited staff resources

new County and City budget cuts

Insufficient knowledge/skills, access to training

lack knowledge of industry HIT initiatives/opportunities

computer skills; IT management; project management

Information systems issues

paper records reliance

inadequate/dated IT (hardware, software)

stand alone/siloed IS

HIT--The Challenges to Adoption

Additional Costs Issues

Automating core processes—that tie into EMR/ interoperability functionality

Facilities enhancements--including inadequate space, electrical and communications wiring; air conditioning)

PC training

Funding for EMR and Interoperability Initiatives may be insufficient…to establish functional effective IT infrastructure and/or interoperability…precludes LHD involvement

Suggestions for Policy Development/Refinement

Meaningful Use !

plus Meaningful…

  • Requirements

  • Funding

  • Partnerships

  • Planning

  • Monitoring/Progress

Meaningful Requirements

Require applicants to….

  • Outline requirements for engaging safetynet/ publicly-funded providers

  • Detail the extent to which partners’ IT systems are incorporated to maximize interoperability—and meet each other’s need for data

  • Demonstrate how will improve public health IT infrastructure supporting emergency preparedness functions

    Utilize the power of the RFP/RFA…

Set-asides might be necessary to…

assure support and strengthening of the traditional “have-not” providers, i.e, public sector/safetynet providers

fund organizations relative to need; proportional to providers’ resource access, etc

establish other IT critical to effective implementation of EMRs/interoperability

engage currently excluded providers (FQHC Look-Alikes; Behavioral providers, etc)

Meaningful Funding


Will safetynet organizations apply?

Will resources be available to facilitate their application

Incentives Stipulations

Scaling incentives—so orgs which started, but lag behind IT adoption also receive some payments

Some “have-not” providers will not get…

seed monies

incentive payments

Meaningful Funding

Engaging publicly funded facilities/safetynet providers

Documented/measurable participation/engagement

Evidence of impact on/contribution of partner

Is there a need to consider exemptions to RHIO fees/

support for fees payment?

“Meaningful” Partnerships

Planning and prioritizing components of HIT Projects

EMR Functionality—Turn on key functionalities

Clinical reminders

Reporting/querying capacity

Supporting other IT needs

Case Management systems

Lab systems

Establishing critical interoperability

Interoperability within the organization (replace paper systems)

24/7 real time automated reporting

“Meaningful” Planning

Closely tracking progress of HIT/Interoperability Initiatives

Among “Haves” and “Have Nots”

Who has started/not started?

What are the hurdles/barriers?

Track to assure the no one lags

Taking corrective action to address major hurdles

By 2011—Who is lagging? Who is gaining?

By 2014—Who has gained? Who has lagged?

“Meaningful” Monitoring/Progress

Improved safetynet infrastructure Initiatives

Enhanced PH IT Infrastructure

Increased interoperability/data sharing

Efficient/effective health care!

Improved patient and community health!

Health care cost savings!

Meaningful Outcomes…

Contact: Initiatives


Contact: Valerie Rogers, MPH

Thank You!