local health department perspective
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Local Health Department Perspective. Electronic Medical Record Software and Health Information Exchanges. Kathleen Cook Information & Fiscal Manager, Lincoln-Lancaster County Health Department NACCHO Representative to PHDSC. LHDs have two perspectives. Direct care provider. - PowerPoint PPT PresentationTRANSCRIPT
Local Health Department Perspective
Electronic Medical Record Software and Health Information Exchanges
•Kathleen Cook•Information & Fiscal Manager, Lincoln-Lancaster County Health Department•NACCHO Representative to PHDSC
LHDs have two perspectives
Direct care provider
Public health authority
Direct Care ProviderSupport direct service efficientlyReduce errorsSupport quality assurance and improvement effortsFacilitate transfer of information needed to provide care
Laboratory testingReferralsPrescriptions
Direct Care Provider:
Eliminate paper records
Promote consistency and quality of care
Improve ability to monitor performance
Communicate accurately and quickly
Measure outcomes and monitor indicators
CCHIT certified
Master patient index
Off the shelf
No or very limited customization
Training / Informatics competencies of front line staff
Selecting & implementing Electronic Medical Record
Selecting & implementing Electronic Medical Record
Adapt work processes and work flow in software
Medical record vs. reporting
Standard Processes
Public Health AuthoritySurveillance and responseHealth status and disease monitoringPopulation-based health care / quality improvementHealth care access and utilizationHealth education & communicationPopulation-based research
LHD as Public Health Authority: What we need
Access to aggregate data
Access to near real time data for reportable diseases
Access to near real time surveillance information
Identification of populations at risk
Access to immunization information
Advisories regarding events, outbreaksIdentification of populations at riskGuidelines, recommendations, schedulesAnalysis of quality measuresCase & syndrome definitionsDiagnostic guidelines & criteriaCoordination and facilitation of scarce community resources
LHD as Public Health Authority: What we provide
Opportunities / Challenges
HIT Stimulus funding
State eHealth Plan
HIT Resource Center
Local / State Health Information Exchange
Electronic Medical Records
Health Information Exchange
Participant memberInterfaces
Evaluation of quality of care
Public health partnerDecision support
Access to aggregate data
Health information exchangeLaboratories
State immunization registry
Dentrix (in-house dental software)
Pharmacy
Consults & referrals
Case management partners
Health care access referrals
Dental provider referrals and partners
Direct Care Provider: Participant Member
Public Health PartnerTo develop meaningful use functionality
Clinical decision support
Meet public health objectives and measuresImmunizationPublic health alertsPopulation measuresSurveillance measuresClinical and community dashboards
Vaccine need / distributionDetermine population at highest risk by provider (phone/fax/mail)Distribute vaccine and notify high risk patients where/how they can obtain (provider office contacted)
Decision supportProvide alert to physician at point of service (physician advisory-fax/ e-mail)
Community Health StatusIncidence of flu-like illness and level of severity (sentinel physicians, school absenteeism)Providers update state immunization registry (LHD providing data entry)LHD estimate immunity levels in the community
OverallHigh risk populations
H1N1—What we could have done IF… Local HIE
Public Health: H1N1—What we were able to do with EMR
Set up phone bank and schedule people for appointments
Export all H1N1 immunization information to state registry electronically
Report #s by risk and age categories
State eHealth PlaneHealth Council includes public health representation from both state and local levelPublic Health Workgroup Report submitted October 12th included:
Assessment of data available from EMRs that public health needsInformation public health can provide for clinical supportState of readiness of public health to accept / exchange information electronicallyRelationship to national discussion regarding meaningful useRecommended stage approach to interoperability between public health and EMR/HIE systemsIdentified barriers / challenges for public health
Staged Approach
First stageImmunization
Reportable disease
Syndrome surveillance
Second StagePublic health disease registries
Staged Approach
Third stageDevelop chronic disease registry
Fourth StageKnowledge management
Evaluate quality and effectiveness of health care system
Decision support
Return on InvestmentEvaluate technologies and cost effectiveness for implementation at state or local levelImprove response capacity and effectiveness (Response is always local)Public health critical to assuring all providers can meet meaningful use criteria
Reduction of time & effort by provider for required reportingAccess to public health advisories, guidelines and recommendationsParticipation & access to quality of care review & analysisAccess to immunization histories
ChallengesPublic health infrastructure and capacity varies widelyFew EMRs come “off the shelf” with interfaces for key public health reporting systemsPublic health systems still siloed within program areasPrivacy & SecurityCost: dollars, time and human resourcesExpectations about timeliness, quantity and relevance of data
FutureShare the burden
Share the success
Healthier people
Healthier communities
Access for all